hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|GA,attester_name,"To the best of its knowledge and belief, this 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 in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula."
"Evans Memorial Hospital",3/27/2026,3.0.0,"Evans Memorial Hospital","200 North River St Claxton, GA 30417",,582257925,,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_PLAN|Commercial|negotiated_dollar,standard_charge|AETNA_PLAN|Commercial|negotiated_percentage,standard_charge|AETNA_PLAN|Commercial|negotiated_algorithm,median_amount|AETNA_PLAN|Commercial,10th_percentile|AETNA_PLAN|Commercial,90th_percentile|AETNA_PLAN|Commercial,count|AETNA_PLAN|Commercial,standard_charge|AETNA_PLAN|Commercial|methodology,additional_payer_notes|AETNA_PLAN|Commercial,standard_charge|AETNA_MEDICARE_HMO_PLAN|HMO|negotiated_dollar,standard_charge|AETNA_MEDICARE_HMO_PLAN|HMO|negotiated_percentage,standard_charge|AETNA_MEDICARE_HMO_PLAN|HMO|negotiated_algorithm,median_amount|AETNA_MEDICARE_HMO_PLAN|HMO,10th_percentile|AETNA_MEDICARE_HMO_PLAN|HMO,90th_percentile|AETNA_MEDICARE_HMO_PLAN|HMO,count|AETNA_MEDICARE_HMO_PLAN|HMO,standard_charge|AETNA_MEDICARE_HMO_PLAN|HMO|methodology,additional_payer_notes|AETNA_MEDICARE_HMO_PLAN|HMO,standard_charge|AETNA_MEDICARE_POS_PLAN|POS|negotiated_dollar,standard_charge|AETNA_MEDICARE_POS_PLAN|POS|negotiated_percentage,standard_charge|AETNA_MEDICARE_POS_PLAN|POS|negotiated_algorithm,median_amount|AETNA_MEDICARE_POS_PLAN|POS,10th_percentile|AETNA_MEDICARE_POS_PLAN|POS,90th_percentile|AETNA_MEDICARE_POS_PLAN|POS,count|AETNA_MEDICARE_POS_PLAN|POS,standard_charge|AETNA_MEDICARE_POS_PLAN|POS|methodology,additional_payer_notes|AETNA_MEDICARE_POS_PLAN|POS,standard_charge|AETNA_MEDICARE_PPO_PLAN|PPO|negotiated_dollar,standard_charge|AETNA_MEDICARE_PPO_PLAN|PPO|negotiated_percentage,standard_charge|AETNA_MEDICARE_PPO_PLAN|PPO|negotiated_algorithm,median_amount|AETNA_MEDICARE_PPO_PLAN|PPO,10th_percentile|AETNA_MEDICARE_PPO_PLAN|PPO,90th_percentile|AETNA_MEDICARE_PPO_PLAN|PPO,count|AETNA_MEDICARE_PPO_PLAN|PPO,standard_charge|AETNA_MEDICARE_PPO_PLAN|PPO|methodology,additional_payer_notes|AETNA_MEDICARE_PPO_PLAN|PPO,standard_charge|AMBETTER_PLAN|Commercial|negotiated_dollar,standard_charge|AMBETTER_PLAN|Commercial|negotiated_percentage,standard_charge|AMBETTER_PLAN|Commercial|negotiated_algorithm,median_amount|AMBETTER_PLAN|Commercial,10th_percentile|AMBETTER_PLAN|Commercial,90th_percentile|AMBETTER_PLAN|Commercial,count|AMBETTER_PLAN|Commercial,standard_charge|AMBETTER_PLAN|Commercial|methodology,additional_payer_notes|AMBETTER_PLAN|Commercial,standard_charge|AMERIGROUP_PLAN|Medicaid|negotiated_dollar,standard_charge|AMERIGROUP_PLAN|Medicaid|negotiated_percentage,standard_charge|AMERIGROUP_PLAN|Medicaid|negotiated_algorithm,median_amount|AMERIGROUP_PLAN|Medicaid,10th_percentile|AMERIGROUP_PLAN|Medicaid,90th_percentile|AMERIGROUP_PLAN|Medicaid,count|AMERIGROUP_PLAN|Medicaid,standard_charge|AMERIGROUP_PLAN|Medicaid|methodology,additional_payer_notes|AMERIGROUP_PLAN|Medicaid,standard_charge|BCBS_HMO_PLAN|HMO|negotiated_dollar,standard_charge|BCBS_HMO_PLAN|HMO|negotiated_percentage,standard_charge|BCBS_HMO_PLAN|HMO|negotiated_algorithm,median_amount|BCBS_HMO_PLAN|HMO,10th_percentile|BCBS_HMO_PLAN|HMO,90th_percentile|BCBS_HMO_PLAN|HMO,count|BCBS_HMO_PLAN|HMO,standard_charge|BCBS_HMO_PLAN|HMO|methodology,additional_payer_notes|BCBS_HMO_PLAN|HMO,"standard_charge|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS|negotiated_dollar","standard_charge|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS|negotiated_percentage","standard_charge|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS|negotiated_algorithm","median_amount|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS","10th_percentile|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS","90th_percentile|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS","count|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS","standard_charge|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS|methodology","additional_payer_notes|BCBS_OPEN_ACCESS_PLAN|OPEN ACCESS",standard_charge|BCBS_PATHWAY_PLAN|PATHWAY|negotiated_dollar,standard_charge|BCBS_PATHWAY_PLAN|PATHWAY|negotiated_percentage,standard_charge|BCBS_PATHWAY_PLAN|PATHWAY|negotiated_algorithm,median_amount|BCBS_PATHWAY_PLAN|PATHWAY,10th_percentile|BCBS_PATHWAY_PLAN|PATHWAY,90th_percentile|BCBS_PATHWAY_PLAN|PATHWAY,count|BCBS_PATHWAY_PLAN|PATHWAY,standard_charge|BCBS_PATHWAY_PLAN|PATHWAY|methodology,additional_payer_notes|BCBS_PATHWAY_PLAN|PATHWAY,standard_charge|BCBS_PPO_PLAN|PPO|negotiated_dollar,standard_charge|BCBS_PPO_PLAN|PPO|negotiated_percentage,standard_charge|BCBS_PPO_PLAN|PPO|negotiated_algorithm,median_amount|BCBS_PPO_PLAN|PPO,10th_percentile|BCBS_PPO_PLAN|PPO,90th_percentile|BCBS_PPO_PLAN|PPO,count|BCBS_PPO_PLAN|PPO,standard_charge|BCBS_PPO_PLAN|PPO|methodology,additional_payer_notes|BCBS_PPO_PLAN|PPO,standard_charge|CARE_IMPROVEMENT_PLUS_PLAN|Medicare|negotiated_dollar,standard_charge|CARE_IMPROVEMENT_PLUS_PLAN|Medicare|negotiated_percentage,standard_charge|CARE_IMPROVEMENT_PLUS_PLAN|Medicare|negotiated_algorithm,median_amount|CARE_IMPROVEMENT_PLUS_PLAN|Medicare,10th_percentile|CARE_IMPROVEMENT_PLUS_PLAN|Medicare,90th_percentile|CARE_IMPROVEMENT_PLUS_PLAN|Medicare,count|CARE_IMPROVEMENT_PLUS_PLAN|Medicare,standard_charge|CARE_IMPROVEMENT_PLUS_PLAN|Medicare|methodology,additional_payer_notes|CARE_IMPROVEMENT_PLUS_PLAN|Medicare,standard_charge|CARE_NETWORK_PLAN|Commercial|negotiated_dollar,standard_charge|CARE_NETWORK_PLAN|Commercial|negotiated_percentage,standard_charge|CARE_NETWORK_PLAN|Commercial|negotiated_algorithm,median_amount|CARE_NETWORK_PLAN|Commercial,10th_percentile|CARE_NETWORK_PLAN|Commercial,90th_percentile|CARE_NETWORK_PLAN|Commercial,count|CARE_NETWORK_PLAN|Commercial,standard_charge|CARE_NETWORK_PLAN|Commercial|methodology,additional_payer_notes|CARE_NETWORK_PLAN|Commercial,standard_charge|CARESOURCE_PLAN|Medicaid|negotiated_dollar,standard_charge|CARESOURCE_PLAN|Medicaid|negotiated_percentage,standard_charge|CARESOURCE_PLAN|Medicaid|negotiated_algorithm,median_amount|CARESOURCE_PLAN|Medicaid,10th_percentile|CARESOURCE_PLAN|Medicaid,90th_percentile|CARESOURCE_PLAN|Medicaid,count|CARESOURCE_PLAN|Medicaid,standard_charge|CARESOURCE_PLAN|Medicaid|methodology,additional_payer_notes|CARESOURCE_PLAN|Medicaid,standard_charge|CIGNA_PLAN|Commercial|negotiated_dollar,standard_charge|CIGNA_PLAN|Commercial|negotiated_percentage,standard_charge|CIGNA_PLAN|Commercial|negotiated_algorithm,median_amount|CIGNA_PLAN|Commercial,10th_percentile|CIGNA_PLAN|Commercial,90th_percentile|CIGNA_PLAN|Commercial,count|CIGNA_PLAN|Commercial,standard_charge|CIGNA_PLAN|Commercial|methodology,additional_payer_notes|CIGNA_PLAN|Commercial,standard_charge|HUMANA_CHOICECARE_PLAN|Medicare|negotiated_dollar,standard_charge|HUMANA_CHOICECARE_PLAN|Medicare|negotiated_percentage,standard_charge|HUMANA_CHOICECARE_PLAN|Medicare|negotiated_algorithm,median_amount|HUMANA_CHOICECARE_PLAN|Medicare,10th_percentile|HUMANA_CHOICECARE_PLAN|Medicare,90th_percentile|HUMANA_CHOICECARE_PLAN|Medicare,count|HUMANA_CHOICECARE_PLAN|Medicare,standard_charge|HUMANA_CHOICECARE_PLAN|Medicare|methodology,additional_payer_notes|HUMANA_CHOICECARE_PLAN|Medicare,standard_charge|HUMANA_TRICARE_PLAN|Commercial|negotiated_dollar,standard_charge|HUMANA_TRICARE_PLAN|Commercial|negotiated_percentage,standard_charge|HUMANA_TRICARE_PLAN|Commercial|negotiated_algorithm,median_amount|HUMANA_TRICARE_PLAN|Commercial,10th_percentile|HUMANA_TRICARE_PLAN|Commercial,90th_percentile|HUMANA_TRICARE_PLAN|Commercial,count|HUMANA_TRICARE_PLAN|Commercial,standard_charge|HUMANA_TRICARE_PLAN|Commercial|methodology,additional_payer_notes|HUMANA_TRICARE_PLAN|Commercial,standard_charge|IBG_PLAN|Commercial|negotiated_dollar,standard_charge|IBG_PLAN|Commercial|negotiated_percentage,standard_charge|IBG_PLAN|Commercial|negotiated_algorithm,median_amount|IBG_PLAN|Commercial,10th_percentile|IBG_PLAN|Commercial,90th_percentile|IBG_PLAN|Commercial,count|IBG_PLAN|Commercial,standard_charge|IBG_PLAN|Commercial|methodology,additional_payer_notes|IBG_PLAN|Commercial,standard_charge|MEDICAID_PLAN|MEDICAID|negotiated_dollar,standard_charge|MEDICAID_PLAN|MEDICAID|negotiated_percentage,standard_charge|MEDICAID_PLAN|MEDICAID|negotiated_algorithm,median_amount|MEDICAID_PLAN|MEDICAID,10th_percentile|MEDICAID_PLAN|MEDICAID,90th_percentile|MEDICAID_PLAN|MEDICAID,count|MEDICAID_PLAN|MEDICAID,standard_charge|MEDICAID_PLAN|MEDICAID|methodology,additional_payer_notes|MEDICAID_PLAN|MEDICAID,standard_charge|MEDICARE_PLAN|MEDICARE|negotiated_dollar,standard_charge|MEDICARE_PLAN|MEDICARE|negotiated_percentage,standard_charge|MEDICARE_PLAN|MEDICARE|negotiated_algorithm,median_amount|MEDICARE_PLAN|MEDICARE,10th_percentile|MEDICARE_PLAN|MEDICARE,90th_percentile|MEDICARE_PLAN|MEDICARE,count|MEDICARE_PLAN|MEDICARE,standard_charge|MEDICARE_PLAN|MEDICARE|methodology,additional_payer_notes|MEDICARE_PLAN|MEDICARE,standard_charge|PEACHSTATE_PLAN|Medicare|negotiated_dollar,standard_charge|PEACHSTATE_PLAN|Medicare|negotiated_percentage,standard_charge|PEACHSTATE_PLAN|Medicare|negotiated_algorithm,median_amount|PEACHSTATE_PLAN|Medicare,10th_percentile|PEACHSTATE_PLAN|Medicare,90th_percentile|PEACHSTATE_PLAN|Medicare,count|PEACHSTATE_PLAN|Medicare,standard_charge|PEACHSTATE_PLAN|Medicare|methodology,additional_payer_notes|PEACHSTATE_PLAN|Medicare,standard_charge|UHC_PLAN|Commercial|negotiated_dollar,standard_charge|UHC_PLAN|Commercial|negotiated_percentage,standard_charge|UHC_PLAN|Commercial|negotiated_algorithm,median_amount|UHC_PLAN|Commercial,10th_percentile|UHC_PLAN|Commercial,90th_percentile|UHC_PLAN|Commercial,count|UHC_PLAN|Commercial,standard_charge|UHC_PLAN|Commercial|methodology,additional_payer_notes|UHC_PLAN|Commercial,standard_charge|VA_CCN_PLAN|MEDICARE|negotiated_dollar,standard_charge|VA_CCN_PLAN|MEDICARE|negotiated_percentage,standard_charge|VA_CCN_PLAN|MEDICARE|negotiated_algorithm,median_amount|VA_CCN_PLAN|MEDICARE,10th_percentile|VA_CCN_PLAN|MEDICARE,90th_percentile|VA_CCN_PLAN|MEDICARE,count|VA_CCN_PLAN|MEDICARE,standard_charge|VA_CCN_PLAN|MEDICARE|methodology,additional_payer_notes|VA_CCN_PLAN|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
"CRITICAL CARE FOR NEWBORN",501159,CDM,171,RC,99468,HCPCS,INPATIENT,,,1350,1080,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1886.9,,,,,,0,"per diem","pays based on per day rate",1886.9,,,,,,0,"per diem","pays based on per day rate",1886.9,,,,,,0,"per diem","pays based on per day rate",2100.6,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,other,"not separately reimbursable",1215,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",927.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",600,2100.6,
"DAKIN'S SOLUTION HALF STRENGTH 0.25%",2661916,CDM,250,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"LIDOCAINE 2.5%/ PRILOCAINE 2.5% CREAM",2605153,CDM,250,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NEXSTAT TOPICAL POWDER",2600182,CDM,250,RC,,,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,589.5,
"NF-ELA-MAX (LIDOCAINE) 4% CREAM : 5GM",2603015,CDM,250,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CYCLOGYL (CYCLOPENTOLATE)OPHTH DROP (OR)",2602226,CDM,250,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"LATANOPROST 0.005% EYE DROPS 2.5ML",2610193,CDM,250,RC,,,OUTPATIENT,,,19,15.2,,16.15,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.65,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.02,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",16.15,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.87,17.1,
"NEOSYNEPH 10% (PHENYLEPHRINE) OPHT DROP",2605181,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"NEOSYNEPH 2.5% (PHENYLEPHRINE)OPHT DROP",2600326,CDM,250,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"OCUFLOX (OFLOXACIN) 0.3% OPTH DROPS 10ML",2600026,CDM,250,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"PREDNISOLONE SOD PHOS 1% OPTH SOLN 10ML",2610158,CDM,250,RC,,,OUTPATIENT,,,119.12,95.3,,101.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.78,25,,,,,0,"percent of total billed charges","25% of total billed charges",29.78,25,,,,,0,"percent of total billed charges","25% of total billed charges",29.78,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",107.21,90,,,,,0,"percent of total billed charges","90% of total billed charges",41.69,35,,,,,0,"percent of total billed charges","35% of total billed charges",81.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",107.21,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.09,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",101.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.26,107.21,
"TETRACAINE 0.5% EYE DROPS 15ML",2600071,CDM,250,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"TOBRADEX (TOBRAMYCIN/DEX) OPHT DROP",2600336,CDM,250,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"EYEWASH (COLLYRIUM) 4OZ SOLUTION",2600305,CDM,250,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"FSBS (FINGER STICK BLOOD SUGAR) : 1EA",2699999,CDM,250,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ACTIDOSE(CHARCOAL) W/SORBITOL 50GM/240ML",2600801,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"ANCEF (CEFAZOLIN) INJ 2GM",2610132,CDM,250,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZOSYN INJ 2.25GM",2600133,CDM,250,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"DEXTROSE 25% SYRINGE 10ML",2600129,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MAGNESIUM SULFATE 2GM IV PREMIX",2600183,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"AMMONIA INHALANT",2600181,CDM,250,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BUPIVACAINE 0.5% W/ EPI 1:200,000 DENTAL",2600135,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DURAGESIC (FENTANYL) PATCH 100MCG",2602612,CDM,250,RC,,,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,346.5,
"FLOVENT (FLUTICASONE) HFA INH 110MCG",2610122,CDM,250,RC,,,OUTPATIENT,,,575,460,,488.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",143.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",143.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",117.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",517.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",201.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",395.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",517.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",333.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",117.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",488.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",117.13,517.5,
"NITROGLYCERIN DRIP 50MG/250ML",2601367,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"PRECEDEX 400MCG/100ML VIAL",2610172,CDM,250,RC,J3490,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"K PHOS 22MEQ/NS 100ML MINIBAG PREDEFINED",2610114,CDM,250,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"KCL 20MEQ IN SW MINIBAG IV 20MEQ PREMIX",2605171,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"K-PHOS (POTASSIUM PHOS) INJ 4.4MEQ VIAL",2610112,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SOD BICARBONATE 8.4% INJ 50MEQ",2600061,CDM,250,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"ACETAMINOPHEN 1000MG/100ML IV",2610127,CDM,250,RC,J0131,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ACTIVASE (ALTEPLASE) 100MG VIAL",2605133,CDM,250,RC,,,OUTPATIENT,,,20010,16008,,17008.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5002.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5002.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5002.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4076.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",18009,90,,,,,0,"percent of total billed charges","90% of total billed charges",7003.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",13746.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18009,90,,,,,0,"percent of total billed charges","90% of total billed charges",11605.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",4076.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17008.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,18009,
"ALBUTEROL NEBULIZER SOL 1.25MG/3ML",2600179,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ALBUTEROL NEBULIZER SOL 2.5MG/3ML",2610541,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ALBUTEROL NEBULIZER SOL 2.5MG/3ML",2699994,CDM,250,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"ALBUTEROL ORAL SOL 2MG/5ML",2600894,CDM,250,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AREDIA (PAMIDRONATE) 90MG INJ",2605010,CDM,250,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"ATROVENT (IPRATROPIUM TX) NEB  0.5MG",2699993,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BREVITAL SODIUM (METHOHEXITAL) 500MG INJ",2600190,CDM,250,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"BUMEX (BUMETANIDE) INJ 1MG",2601275,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CARDENE (NICARDIPINE) INJ 25MG",2610125,CDM,250,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"CARDIZEM (DILTIAZEM) INJ 25MG",2601016,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATHFLO (ALTEPLASE) 2MG INJ",2600193,CDM,250,RC,J2997,HCPCS,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",118.92,130,,,,,0,"fee schedule","130% of CMS OPPS rate",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",93.3,102,,,,,0,"fee schedule","102% of CMS OPPS rate",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",82.33,90,,,,,0,"fee schedule","90% of CMS OPPS rate",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS OPPS rate",82.33,427.5,
"CIPRO (CIPROFLOXACIN) 200MG IV PREMIX",2601027,CDM,250,RC,J0744,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"CIPRO (CIPROFLOXACIN) 400MG IV PREMIX",2601023,CDM,250,RC,J0744,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"CLEOCIN 300MG/50ML IVPB PREMIX",2600113,CDM,250,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CLEOCIN 600MG/50ML IVPB PREMIX",2630003,CDM,250,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"CLEOCIN 900MG/50ML IVPB PREMIX",2605062,CDM,250,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"CLINDAMYCIN 600MG/4ML VIAL",2601007,CDM,250,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"CLINDAMYCIN 900MG/6ML VIAL",2600180,CDM,250,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CORLOPAM (FENOLDOPAM) INJ : 20MG",2605140,CDM,250,RC,,,OUTPATIENT,,,2420,1936,,2057,85,,,,,0,"percent of total billed charges","85% of total billed charges",605,25,,,,,0,"percent of total billed charges","25% of total billed charges",605,25,,,,,0,"percent of total billed charges","25% of total billed charges",605,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",492.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1367.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1367.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1367.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1367.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2178,90,,,,,0,"percent of total billed charges","90% of total billed charges",847,35,,,,,0,"percent of total billed charges","35% of total billed charges",1662.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2178,90,,,,,0,"percent of total billed charges","90% of total billed charges",1403.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",492.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2057,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",492.95,2178,
"DECADRON (DEXAMETHASONE) NEB 2MG",2699985,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DIDRONEL (ETIDRONATE DISODIUM) INJ: 50MG",2605162,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DIFLUCAN (FLUCONAZOLE) 200MG IV PREMIX",2601295,CDM,250,RC,J1450,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.99,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.88,162,
"DIFLUCAN (FLUCONAZOLE) 400MG IV PREMIX",2601296,CDM,250,RC,J1450,HCPCS,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.99,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.88,175.5,
"DIPRIVAN (PROPOFOL 1%) VIAL 20ML",2601151,CDM,250,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"DOBUTREX (DOBUTAMINE) INJ 250MG",2600057,CDM,250,RC,J1250,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.9,40.5,
"DOPAMINE IV 400MG/D5W 250ML",2601306,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"EPHEDRINE INJ 50MG",2601312,CDM,250,RC,J0169,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ESMOLOL 2500MG/250ML PREMIX",2600176,CDM,250,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"ETOMIDATE INJ : 20MG/10ML",2605139,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"FERRLECIT (IRON GLUCONATE) INJ 12.5MG/ML",2600185,CDM,250,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"FLAGYL (METRONIDAZOLE) 500MG IVPB",2602314,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"KETALAR (KETAMINE) INJ 500MG",2601303,CDM,250,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"LEVOPHED (NOREPINEPHRINE) INJ 4MG/4ML",2601009,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LOPRESSOR (METOPROLOL) INJ 5MG",2601347,CDM,250,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MUCOMYST (ACETYLCYSTEINE) 4ML NEB",2619209,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NF-TEQUIN (GATIFLOXACIN) IV : 400MG",2605053,CDM,250,RC,,,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,265.5,
"NORCURON (VECURONIUM) INJ 10MG",2603004,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ORPHENADRINE (NORFLEX) 60MG/2ML AMP",2600121,CDM,250,RC,J2360,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.84,184.5,
"PEPCID (FAMOTIDINE) INJ 20MG",2600087,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PRIMACOR (MILRINONE) INJ 20MG",2605046,CDM,250,RC,,,OUTPATIENT,,,495,396,,420.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",123.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",123.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",123.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",100.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",445.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",173.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",340.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",445.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",287.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",100.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",420.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",100.83,445.5,
"PRIMAXIN (IMIPENEM/CILASTATIN) 500MG",2600114,CDM,250,RC,,,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,265.5,
"PROCAN IV (PROCAINAMIDE HCL) INJ 500MG",2601379,CDM,250,RC,J2690,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",237.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",186.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",164.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",220.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.03,100,,,,,0,"fee schedule","100% of CMS OPPS rate",25.43,237.93,
"PROPOFOL 1000MG/100ML VIAL",2610142,CDM,250,RC,J2704,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PROTONIX (PANTOPRAZOLE) INJ 40MG",2605174,CDM,250,RC,,,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"PULMICORT 0.25MG(BUDESONIDE)",2605142,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PULMICORT 0.5MG(BUDESONIDE)",2699987,CDM,250,RC,J7626,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"RACEMIC EPI",2619121,CDM,250,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"RACEMIC EPI NEB TX NEB",2699986,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"RIFAMPIN 600MG VIAL",2600118,CDM,250,RC,,,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"ROBINUL (GLYCOPYRROLATE) INJ 0.2MG",2601387,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ROMAZICON (FLUMAZENIL) INJ 0.1MG",2601388,CDM,250,RC,,,OUTPATIENT,,,365,292,,310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",91.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",91.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",91.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",74.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",328.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",250.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",328.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",74.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",74.35,328.5,
"SOD NITROPRUSSIDE 50MG/2ML VIAL",2600124,CDM,250,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"XOPENEX 0.31MG(LEVALBUTEROL)",2699990,CDM,250,RC,J7614,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"XOPENEX 0.63MG(LEVALBUTEROL)",2699989,CDM,250,RC,J7614,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"XOPENEX 1.25MG(LEVALBUTEROL)",2699988,CDM,250,RC,J7614,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ZEMURON (ROCURONIUM) INJ 50MG",2603007,CDM,250,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"ZETIA (EZETIMIBE) TAB 10 MG",2602708,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"AA 4.25% DEX 10% c LYTES : 2000ML",2611007,CDM,250,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"AA 4.25% DEX 5% c LYTES : 2000ML",2611008,CDM,250,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"AA 4.5% DEX 10% : 1000ML",2611005,CDM,250,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"ACTEYLCYSTEINE INJ 200MG/ML 30ML VIAL",2605016,CDM,250,RC,J0132,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"ALBUMIN HUMAN 25% IV : 100ML (25GM)",2610016,CDM,250,RC,,,OUTPATIENT,,,630,504,,535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",432.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.33,567,
"ATROPINE OPTH SOLN 1% 5ML",2601265,CDM,250,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"BACTRIM (SMP/TMP) INJ 10ML",2601017,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"BOOST/FIB (ENTERAL FORMULA) GT : 240ML",2620009,CDM,250,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CANDIDA SKIN TEST INJ 0.1ML",2601401,CDM,250,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"D5W 0.2% NS 1000ML",2600077,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W 0.2% NS W/KCL 20MEQ 1000ML",2611003,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W IV SOLN  1000ML",2610010,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.2% SOD CL IV SOLN 250ML",2611004,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.45% NS IV SOLN 1000ML",2610015,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.45% NS KCL 10MEQ IV SOLN 1000ML",2610041,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.45% NS KCL 20MEQ IV SOLN 1000ML",2610009,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.45% NS KCL 40MEQ IV SOLN 1000ML",2610002,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.9% NS/KCL 20 MEQ IV SOLN 1000ML",2610044,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.9% NS/KCL 40 MEQ IV SOLN 1000ML",2605173,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/0.9% SODIUM CHLORIDE IV SOLN 1000ML",2610020,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/KCL 20 MEQ IV SOLN 1000ML",2610006,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"D5W/KCL 40 MEQ IV SOLN 1000ML",2610040,CDM,250,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"D5W/LACTATED RINGERS IV SOLN 1000ML",2610028,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"DEXTROSE 10% 500ML",2610035,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"DEXTROSE 5% INJ 25ML",2610067,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DEXTROSE 5% IV 100ML",2610013,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"DEXTROSE 5% IV 250ML",2610012,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"DEXTROSE 5% IV 500ML",2610011,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"DEXTROSE 50% SYRINGE 25GM : 50ML",2600053,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"HEPARIN 25,000U/D5W 500ML",2601307,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"HYPERSAL(NACL)7% NEB",2600189,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LET GEL TOPICAL SYRINGE 3ML",2605141,CDM,250,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"LIDOCAINE 2GM/500ML IV PREMIX DRIP",2601354,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"LIPOSYN 10% (LIPID EMULSION) IV : 1ML",2610068,CDM,250,RC,,,OUTPATIENT,,,110,88,,93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",75.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,99,
"LIPOSYN 20% (LIPID EMULSION)500 ML",2611006,CDM,250,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"LR 1000ML / PITOCIN 20 UNITS PREMIX",2601374,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"LR IV SOLN 1000ML",2610022,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"MAG SULFATE (40GM/L) 1000ML",2601370,CDM,250,RC,J3475,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.61,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.59,135,
"MANNITOL 20% IVPB 500ML",2602700,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"MARCAINE (BUPIVACAINE) 0.25% VL 10ML",2600032,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MARCAINE (BUPIVACAINE) 0.5% VL 10ML",2601359,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MARCAINE 0.25% W/EPI(BUPIVACAINE)VL 10ML",2601358,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MARCAINE 0.5% (BUPIVACAINE) VIAL 10ML",2603020,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MUCOMYST  20% ORAL SOL 30ML",2605015,CDM,250,RC,J7608,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MULTITRACE-4 (TRACE ELEMENTS) INJ 1ML",2603078,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MULTIVITAMIN-12 INJ 10ML",2610056,CDM,250,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MUMPS SKIN TEST INJ : 0.1ML",2601398,CDM,250,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"NACL 0.45% / KCL 20MEQ 1000ML",2610071,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NACL 0.45% 1000ML IV SOL",2610024,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NACL 0.9% / KCL 20MEQ 1000ML",2610003,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NACL 0.9% / KCL 40MEQ 1000ML",2605172,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NACL 0.9% 10ML INJ",2610503,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NACL 0.9% 50ML IVPB",2610031,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NACL 0.9% 50ML MINIBAG PLUS",2600037,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NACL 0.9% IVPB 100ML",2610030,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NF-D5W/LACT RINGERS/KCL 20 MEQ 1000ML",2610046,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NF-D5W/LACT RINGERS/KCL 40 MEQ 1000ML",2610047,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NF-DELIVER 2 (ENTERAL FORMULA) GT 240ML",2620002,CDM,250,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-DEX/ETHAN (DEX 5% ALCOHOL 5%) 500ML",2610036,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"NF-NACL 0.9% 50ML MINIBAG + (ERROR IN #)",260037,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NF-SOD CHLORIDE 0.22% IV SOLN 1000ML",2610049,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NON-FORM IVPB/IVF IV : 1ML",2600089,CDM,250,RC,,,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"NON-FORMULARY INJ",2600097,CDM,250,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"NULYTELY  (PGE-3350 + LYTES) 4000ML",2600044,CDM,250,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"NULYTELY CHERRY(PGE-3350 + LYTES):4000ML",2605165,CDM,250,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OSMOLITE (ENTERAL FORMULA) GT : 240ML",2620010,CDM,250,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PROCALAMI (PROCALAMINE 3% +ELEC) IV:",2610043,CDM,250,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
"PROCALAMINE  AA 3% GLYERIN 3% w LYTES 1L",2611014,CDM,250,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"RIMSO-50 (DIMETHYL SULFOXIDE) 50ML",2600159,CDM,250,RC,,,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,265.5,
"SOD CHLORIDE 0.9% IV SOLN  250ML",2610027,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SOD CHLORIDE 0.9% MINIBAG PLUS 100ML",2600086,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SOD CHLORIDE 0.9% MINIBAG PLUS 50ML",2600088,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SOD CHLORIDE 3% IV SOLN 500ML",2612000,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SODIUM CHLORIDE 0.45% IV SOLN 500ML",2610032,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SODIUM CHLORIDE 0.9% IRRIGATION 1000ML",2610062,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SODIUM CHLORIDE 0.9% IV SOLN 500ML",2610026,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SODIUM CHLORIDE 5% IV SOLN 500ML",2612002,CDM,250,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"SODIUM CHLORIDE NEB SOL 3%/4ML",2610138,CDM,250,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"STERILE WATER FOR INJECTION 1000ML",2600117,CDM,250,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"STERILE WATER INJ 10ML",2610502,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"STERILE WATER IRRIGATION 1000 ML",2660007,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"STERILE WATER IRRIGATION 500 ML",2660008,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"TWO-CAL H (ENTERAL FORMULA) GT 240ML",2620101,CDM,250,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"VISION BLUE (TRYPAN) OPHTH 0.06% 0.5ML",2660015,CDM,250,RC,,,OUTPATIENT,,,260,208,,221,85,,,,,0,"percent of total billed charges","85% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",91,35,,,,,0,"percent of total billed charges","35% of total billed charges",178.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",221,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,234,
"XYLOCAINE 1% W/EPI (LIDO/EPI) VIAL 10ML",2601350,CDM,250,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"XYLOCAINE 2% (LIDOCAINE HCL) JELLY 30ML",2600465,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"XYLOCAINE 2% (LIDOCAINE) JELLY 5ML",2600070,CDM,250,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"XYLOCAINE 2% W/EPI (LIDO/EPI) MPF 10ML",2601351,CDM,250,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"SODIUM PHOS 15MMOL/NS 100ML MINIBAG PRED",2610174,CDM,250,RC,,,OUTPATIENT,,,193,154.4,,164.05,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",109.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",109.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",109.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",109.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",173.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.55,35,,,,,0,"percent of total billed charges","35% of total billed charges",132.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",173.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",111.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",164.05,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.31,173.7,
"SODIUM PHOSPHATE INJ 15MMOL VIAL",2610173,CDM,250,RC,,,OUTPATIENT,,,43,34.4,,36.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.05,35,,,,,0,"percent of total billed charges","35% of total billed charges",29.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.76,38.7,
"LACTINEX (LACTOBACILLUS) GRANULES 1PKT",2602684,CDM,250,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ADVAIR (FLUTIC/SALMETEROL)MDI INH 100-50",2605143,CDM,250,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"ADVAIR (FLUTIC/SALMETEROL)MDI INH 250-50",2605144,CDM,250,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"ADVAIR (FLUTIC/SALMETEROL)MDI INH 500-50",2605145,CDM,250,RC,,,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",168,35,,,,,0,"percent of total billed charges","35% of total billed charges",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",97.78,432,
"AEROBID (FLUNISOLIDE) MDI INH :",2600150,CDM,250,RC,J7641,HCPCS,OUTPATIENT,,,460,368,,391,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",161,35,,,,,0,"percent of total billed charges","35% of total billed charges",316.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",266.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",391,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",93.7,414,
"AZMACORT (TRIAMCINOLONE) INH :",2605066,CDM,250,RC,J7684,HCPCS,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,738,
"COMBIVENT (IPRATROPIUM/ALBUT) INH",2603051,CDM,250,RC,,,OUTPATIENT,,,715,572,,607.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",178.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",178.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",178.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",145.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",643.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",250.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",491.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",643.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",414.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",145.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",607.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",145.65,643.5,
"NON-FORMULARY INHALER",2602290,CDM,250,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"PROVENTIL (ALBUTEROL) HFA INHALER",2600162,CDM,250,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"SEREVENT (SALMETEROL DISK) INH",2602234,CDM,250,RC,,,OUTPATIENT,,,375,300,,318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",131.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",257.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",217.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.39,337.5,
"ATROVENT (IPRATROPIUM BROM) INH :",2600035,CDM,250,RC,,,OUTPATIENT,,,1285,1028,,1092.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",261.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1156.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",449.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",882.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1156.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",745.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",261.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1092.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",261.75,1156.5,
"INSTA-GLUCOSE GEL/JELLY 40%",2662045,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DUONEB NEBULIZER SOL 2.5-0.5MG/3ML",2660028,CDM,250,RC,J7620,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ALBUTEROL (PROVENTIL) RT CHARGE",2619115,CDM,250,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
ATROVENT,2619306,CDM,250,RC,J7644,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
DECADRON,2615555,CDM,250,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"FLUOTHANE (HALOTHANE) GAS",2605004,CDM,250,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"FORANE (ISOFLURANE) GAS",2600048,CDM,250,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"HYSKON (DEXTRAN 70) IV",2605101,CDM,250,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
NACL,2619122,CDM,250,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PPD TEST (TUBERCULIN SKIN TEST) INJ",2601383,CDM,250,RC,86580,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",9.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.7,102,,,,,0,"fee schedule","102% of CMS OPPS rate",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,90,,,,,0,"fee schedule","90% of CMS OPPS rate",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.79,90,
"PROPINE (DIPIVEFRIN) 0.1% OPHTH SOL",2600321,CDM,250,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"RHO (D) IMMUN 300 UG DOSE",2612345,CDM,250,RC,,,OUTPATIENT,,,300,240,,255,85,,,,,0,"percent of total billed charges","85% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",105,35,,,,,0,"percent of total billed charges","35% of total billed charges",206.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",174,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",255,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,270,
"SODIUM CHLORIDE 0.9% IRRIGATION  3000ML",2660006,CDM,250,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SUPRANE (DESFLURANE) GAS",2600049,CDM,250,RC,,,OUTPATIENT,,,1325,1060,,1126.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",331.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",331.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",331.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",269.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",748.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",748.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",748.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",748.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1192.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",463.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",910.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1192.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",768.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",269.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1126.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",269.9,1192.5,
"ULTANE (SEVOFLURANE) GAS",2600043,CDM,250,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
XOPENEX,2619125,CDM,250,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"X-RAY STRESS VIEW",4077071,CDM,250,RC,77071,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",312.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,409.5,
"AR/MYLEO DYE",4000030,CDM,255,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"ARTHRO/MYELOGRAM DYE",4000031,CDM,255,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"CT GASTROGRAFIN 30ML",4000034,CDM,255,RC,Q9963,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,709.88,709.88,709.88,"1 through 10","percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,0.65,0.65,0.65,"1 through 10","percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CT REDI-CAT",4200011,CDM,255,RC,A4641,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",28.52,126,
"NM PERSANTINE 10M IV",4500102,CDM,255,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"NM TC99M HDP",4500038,CDM,255,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NM TC99M MAG 3 PER M",4500012,CDM,255,RC,A9540,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.67,162,
"NM TC99M MICROLITE",4500008,CDM,255,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NM TC99M UNIT DOSE/THYROID",4500002,CDM,255,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34.63,153,
"XR CHOLIGRAFIN IVC",4000032,CDM,255,RC,,,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",175,35,,,,,0,"percent of total billed charges","35% of total billed charges",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",101.85,450,
"XR CYSTO CONRAY",4000037,CDM,255,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NACL 0.9% IV 1000ML",2610025,CDM,258,RC,J7030,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.13,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.01,135,
"BOOSTRIX (TDAP) INJ: 0.5ML",2600184,CDM,259,RC,90715,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",48.36,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",41.25,148.5,
"INSJ PICC 5YR+ W/O IMAGING",1536569,CDM,260,RC,36569,HCPCS,OUTPATIENT,,,5925,4740,,5036.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1481.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1481.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1481.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,1397.27,1397.27,1397.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5332.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2073.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4070.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5332.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3436.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1206.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5036.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206.92,5332.5,
"ETHYL CHLORIDE SPRAY 3.5FL OZ.",2600154,CDM,270,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"HIBICLENS (CHLORHEXIDINE) 4% SCRUB:120ML",2605081,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CLOG ZAPPER",2610134,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"IV SET MICRODRIP",2600023,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"IV SET VENO-78 MIS",2600005,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"OPTICHAMBER (SPACER FOR MDI)",2600148,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"NF-CUBICIN 500MG INTRAVENOUS POWDER FOR",2661964,CDM,270,RC,J0878,HCPCS,OUTPATIENT,,,1465,1172,,1245.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",366.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",366.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",366.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",827.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",827.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",827.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",827.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1318.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1006.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1318.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",849.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1245.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.05,1318.5,
"NF-DAPTOMYCIN IV PWD FOR SOLN 500MG",2668120,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SODIUM CHLORIDE 0.9% IRRIGATION 500ML",2610505,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"ABD BINDER 12  79-89090",7905165,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ABD BINDER 12  79-89091",7905166,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ABD BINDER 12  79-99440",7905420,CDM,270,RC,,,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"ABD BINDER 12  H 2XL MEDLINE",7905356,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"ABD BINDER 12  H 3XL MEDLINE",7905367,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"ABD BINDER 15  79-92149",7905279,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"ABD BINDER 9  79-89070",7905153,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"ABD BINDER 9  79-99430",7905155,CDM,270,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"ABD PAD 9190A",7905002,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ABD PAD NON21450",7905001,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ACAPELLA VIBRATORY BLUE",7915711,CDM,270,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"ACAPELLA VIBRATORY GREEN",7915712,CDM,270,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"ACAPELLA VIBRATORY PEP THERAPY",7915718,CDM,270,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"ACE BANDAGE 4  STERILE",7905681,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"ACE BANDAGE 6  STERILE",7905682,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"ADAPTIC DRG 3 X 3",7905501,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ADAPTIC DRG 3 X 8",7905502,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ADENOSINE HEPLOCK",2662940,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"AEROSOL MASK ADULT 001206",7919200,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AEROSOL MASK ADULT HUD1083",7919201,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AEROSOL MASK PEDIATRIC 001263",5550041,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AEROSOL POCKET CHAMBER 100150",5550004,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AEROSOL POCKET CHAMBER HUD100150",5550051,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AIRWAY NASAL LF 20FR 5075-20",7905750,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASAL LF 22FR 5075-22",7905754,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASAL LF 24FR 5075-24",7905755,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AIRWAY NASAL LF 26FR 5075-26",7905762,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASAL LF 28FR 5075-28",7905763,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASAL LF 30FR 5075-30",7905765,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASAL LF 32FR 5075-32",7905769,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASAL LF 34FR 5075-34",7905771,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AIRWAY NASAL LF 36FR 5075-36",7905772,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AIRWAY NASOPHARYNGEAL",7905759,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"AIRWAY PLASTIC",7905003,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AMBU BAG ADULT",7915822,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"AMBU BAG ADULT SPUR 2 MED FACE MASK",7915823,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"AMBU BAG CHILD",7900002,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"AMBU BAG INFANT",7900001,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"AMBU BAG PED/ TODDLER",7900013,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"AMBU BAG PEDIATRIC NEO,INF W/ MANOMETER",790010,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"AMBU BAG PEDIATRIC NEO,INF,TODDLER MASK",7900005,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
AMNIHOOK,7905004,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ANASTAMOSIS SET",7901204,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"ANKLE BRACE LACE UP MEDLINE M",7905984,CDM,270,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"ANKLE BRACE SMALL",7905159,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANOSCOPE DISP",7905481,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ANOSCOPE DISP W/LIGHT 90MM X 18MM",1750076,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ANOSCOPE DISP W/LIGHT 96MM X 23MM",1750075,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER FEMALE MED",7905150,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER FEMALE XLG",7905169,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER MALE MED",7905171,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER MALE MED BREG",7905365,CDM,270,RC,,,OUTPATIENT,,,106.92,85.54,,90.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.73,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.73,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.73,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",60.41,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",60.41,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",60.41,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",60.41,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.23,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.42,35,,,,,0,"percent of total billed charges","35% of total billed charges",73.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.23,90,,,,,0,"percent of total billed charges","90% of total billed charges",62.01,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",90.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.78,96.23,
"ARM IMMOBILIZER MALE SM",7905170,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM SLEEVE",5007119,CDM,270,RC,,,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"ARM SLING CHILD",7902007,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ARM SLING DEEP POCKET XLG",7905275,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ARM SLING LARGE",7905154,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ARM SLING LARGE 8004-05",7905272,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ARM SLING MEDIUM",7902003,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ARM SLING MEDIUM ASL2104",7905259,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ARM SLING SMALL",7902002,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ARM SLING UNIVERSAL 4535738",7905152,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM SLING UNIVERSAL 5080221",7905214,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM SLING UNIVERSAL LG. ASL2105",7905257,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM SLING UNIVERSAL SMALL ASL2103",7905331,CDM,270,RC,A4565,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARTHROGRAM TRAY",4000800,CDM,270,RC,,,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",129.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",129.35,571.5,
"ARTHROSCOPIC CUTTER",7901220,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"ARTHROSCOPIC PACK",7901226,CDM,270,RC,,,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",175,35,,,,,0,"percent of total billed charges","35% of total billed charges",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",101.85,450,
"ARTHROSCOPY PK IV",7905550,CDM,270,RC,,,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,427.5,
"ASPIRATION SET",7905008,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"BABY PACK C SECTION",7901194,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"BACTERIAL FILTER 1605 HUDSON",7901605,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BAG RESUSCITATOR PED",7900011,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BAIR HUGGER BLANKET",7905321,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BAIR HUGGER BLANKET 42234 UPPER BODY",7905364,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"BAIR HUGGER BLANKET 52500 LOWER",7905319,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BAIR HUGGER BLANKET 62200 UPPER MULTI",7905320,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BALLOON DISSECTION OVAL OMSXB2",7950120,CDM,270,RC,,,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",393.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.16,1012.5,
"BAND AID XL 6136LF",7905140,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BANDAGE ESMARK 4",7905886,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BANDAGE ESMARK 4X9 MEDC SYN",7905889,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BANDAGE ESMARK 6",7905887,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BANDAGE PROFORE",7905425,CDM,270,RC,,,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"BASIC ORTHO INST SET",7901198,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"BASIC OTHO TRAY",7901197,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"BB PLT PALL FILTER",3100701,CDM,270,RC,,,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",107.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",107.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",107.96,477,
"BIOPSY INSTRUMENT MONOPTY 121810",7950207,CDM,270,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"BIOPSY TRAY",4000802,CDM,270,RC,,,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,387,
"BIOPSY TRAY 4382SA",7905109,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BIOPSY TRAY BASIC SPEC4380",7905110,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"BIS SENSOR QUATRO 186-0106",7950238,CDM,270,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"BITE BLOCK BLOX ENDO SBT-546-100",7950167,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BITE BLOCK COMFORT",7950208,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BITE BLOCK ENDO 00712803",7950166,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BITE GUARD",7905796,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"BITE JAWLOCK",7905749,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BLADE OSCILLATING SAW KM-3001",7901051,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"BLADE SAGITTAL SAW KM-3101",1570031,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"BLADE SAGITTAL SAW KM-3107",7901052,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"BLAKE DRAIN 10 MM 2214",7905737,CDM,270,RC,,,OUTPATIENT,,,190,152,,161.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",171,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",130.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",171,90,,,,,0,"percent of total billed charges","90% of total billed charges",110.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",161.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,171,
"BLOOD SET Y-TYP",2610542,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BOOT COMFY FLEECE W/O AMBULATION",7905923,CDM,270,RC,L4396,HCPCS,OUTPATIENT,,,260,208,,221,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",91,35,,,,,0,"percent of total billed charges","35% of total billed charges",178.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",150.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",221,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,234,
"BOOT STANDARD TALL LARGE MAXTRAX",7905911,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"BOOT STANDARD TALL MED MAXTRAX",7905910,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"BOOT STANDARD TALL SMALL MAXTRAX",7905909,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"BOOT XCELTRAX SMALL",7905950,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"BOVIE MACH/HANDTROL",7901009,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"BRA BREAST SUPPORT MEDIUM MEDC BRA102",7950327,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"BRA MEDC AMY SURG BLUSH XLG",7950405,CDM,270,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"BRA SURGICAL BRA103 LARGE",7950358,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"BRA SURGICAL BRA104",7950354,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"BRA SURGICAL BRA105",7950389,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"BRA SURGICAL BRA106",7950363,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"BRA SURGICAL BREAST SUPPORT 2XL",7950306,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT 2XL 42 BLACK",7950381,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"BRA SURGICAL BREAST SUPPORT 2XL 705",7950323,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"BRA SURGICAL BREAST SUPPORT 3XL",7950307,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT 3XL",7950324,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT 3XL 706",7950376,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"BRA SURGICAL BREAST SUPPORT L 38 BLACK",7950395,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"BRA SURGICAL BREAST SUPPORT LARGE",7950304,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT LARGE DL703",7950317,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BRA SURGICAL BREAST SUPPORT M 34 BLACK",7950403,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"BRA SURGICAL BREAST SUPPORT MEDIUM",7950319,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT MEDIUM DL702",7950325,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BRA SURGICAL BREAST SUPPORT SB-LRG",795037,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT SB-MED",7950336,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT SB-XLG",7950326,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT SMALL",7950318,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL BREAST SUPPORT XL 40 BLACK",7950396,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"BRA SURGICAL BREAST SUPPORT XL DL704",7950320,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BRA SURGICAL BREAST SUPPORT XLARGE",7950305,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL CLEARPOINT #216 SZ 40",7950374,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL CLEARPOINT #216 SZ 42",7950367,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL CLEARPOINT #216 SZ 44",7950373,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL CLEARPOINT #216 SZ 46",7950368,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL CURAD 2 XL",7950388,CDM,270,RC,,,OUTPATIENT,,,504,403.2,,428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.32,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,453.6,
"BRA SURGICAL CURAD 3 XL",7950385,CDM,270,RC,,,OUTPATIENT,,,504,403.2,,428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.32,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,453.6,
"BRA SURGICAL CURAD 4 XL",7950370,CDM,270,RC,,,OUTPATIENT,,,504,403.2,,428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.32,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,453.6,
"BRA SURGICAL CURAD 5 XL",7950369,CDM,270,RC,,,OUTPATIENT,,,504,403.2,,428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.32,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,453.6,
"BRA SURGICAL CURAD MED",7950380,CDM,270,RC,,,OUTPATIENT,,,504,403.2,,428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.32,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,453.6,
"BRA SURGICAL CURAD XL",7950387,CDM,270,RC,,,OUTPATIENT,,,504,403.2,,428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",126,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",284.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",453.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.32,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",428.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.66,453.6,
"BRA SURGICAL JUDY LONGLINE MASTHEAD 3XL",7950383,CDM,270,RC,,,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",77.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",133,35,,,,,0,"percent of total billed charges","35% of total billed charges",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",77.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",77.41,342,
"BRA SURGICAL JUDY LONGLINE MASTHEAD 5XL",7950384,CDM,270,RC,,,OUTPATIENT,,,562,449.6,,477.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",140.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",140.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",140.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",114.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",317.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",505.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",196.7,35,,,,,0,"percent of total billed charges","35% of total billed charges",386.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",505.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",325.96,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",477.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",114.48,505.8,
"BRA SURGICAL MEDC AMY BLUSH 3XL",7950404,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"BRA SURGICAL MEDLINE 4XL",7950386,CDM,270,RC,,,OUTPATIENT,,,340,272,,289,85,,,,,0,"percent of total billed charges","85% of total billed charges",85,25,,,,,0,"percent of total billed charges","25% of total billed charges",85,25,,,,,0,"percent of total billed charges","25% of total billed charges",85,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",69.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",192.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",192.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",192.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",192.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",306,90,,,,,0,"percent of total billed charges","90% of total billed charges",119,35,,,,,0,"percent of total billed charges","35% of total billed charges",233.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",306,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",69.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",289,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",69.26,306,
"BRA SURGICAL SB-2XL 3020.6",7950328,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRA SURGICAL SURGI BRA  2XL 518/05",7950382,CDM,270,RC,,,OUTPATIENT,,,370,296,,314.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",75.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",333,90,,,,,0,"percent of total billed charges","90% of total billed charges",129.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",254.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",333,90,,,,,0,"percent of total billed charges","90% of total billed charges",214.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",75.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",314.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",75.37,333,
"BRACE AIRCAST ELITE WALKING MED",7905902,CDM,270,RC,,,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"BRACE DURA STEPPER LARGE",7905917,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"BRACE DURA STEPPER MED",7905916,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"BRACE DURA STEPPER SMALL",7905915,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"BRACE GLOBAL TRACKER S2S WALKER LARGE",7905913,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"BRACE GLOBAL TRACKER S2S WALKER MED",7905908,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"BRACE KNEE PALUMBO 62146 LG",5007540,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"BRACE KNEE PALUMBO 62146 MED",5007532,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"BRACE KNEE PALUMBO 62146 MED/LG",5007533,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"BRACE KNEE PALUMBO 62146 XLG",5007541,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"BRACE SIDEKICK LOW PROFILE WALKER BOOT S",7905906,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"BRACE WRIST C5547620X",7907170,CDM,270,RC,,,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"BREAST PUMP",7950220,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"BREATH CIRCUIT ADLT SNGLE LMB HEAT AH102",7950312,CDM,270,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"BREATHING CIRCUIT ADULT 60",7950250,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BREATHING CIRCUIT ADULT 72  450961-NL",7950371,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"BREATHING CIRCUIT ADULT 72  CURAPLEX",7950375,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BREATHING CIRCUIT ADULT 72  NO MASK",7950356,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BREATHING CIRCUIT C1086",7905156,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"BREATHING CIRCUIT PEDI 40",7950330,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BREATHING CIRCUIT PEDI 72 IN MEDLINE",7950365,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"BREATHING CIRCUIT PEDIATRIC",7905852,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BRIEF ADULT",7905760,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BRIEF ADULT PULL ON LARGE",7905798,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BRIEF ADULT PULL ON MED",7905795,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BRIEF ADULT PULL ON XLARGE",7905799,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BRIEF ADULT XL 66035A",7950178,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BRIEF ADULT XL FITEXTRAXLG",7950172,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CALIBRATION VERIFICATION EUROTROL 1-5",1750084,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"CANISTER VITRUVIAN LIPOSUCTION LF",7950344,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CANNULA ADULT NASAL HIGH FLOW LARGE",7950335,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CANNULA ADULT NASAL HIGH FLOW MED",7950315,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CANNULA ADULT NASAL HIGH FLOW MED VYAIRE",7950353,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CANNULA ADULT NASAL HIGH FLOW SMALL",7950314,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CANNULA CO2 DIVIDED ADULT 4707F-14-14-25",7919141,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA CO2 SAMPLING ADULT",7919114,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA CO2 SAMPLING ADULT 47077725",7919112,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA NASAL HIGH FLOW SMALL",7950360,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CANNULA SOFT TIP ADULT 7 FT",7919132,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"CAPNOLINE O2 0683-00-0496-25",2092964,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CARDIAC (ROUTINE MU ORDERS) MIS",2699998,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"CARDIAC MONITOR ER",2000005,CDM,270,RC,,,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,387,
"CARTRIDGE EPOC BGEM TEST CARD BUN/ ORANG",1750083,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH 16 FR. 6146LL",7905175,CDM,270,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"CATH 16 FR. PP16SD",7905173,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH 18 FR. PP18SD DYND11520",7905174,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH 3-WAY",7905201,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"CATH ALL PURP A/SZ",7905994,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH BARTH GLAND",7905569,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CATH CHOLANGIOGRAM",7905270,CDM,270,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"CATH CHOLANGIOGRAM 20018-M55",7950245,CDM,270,RC,,,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"CATH CHOLANGIOGRAPY SET",7905792,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"CATH COUDE 14 FR.",7905941,CDM,270,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"CATH COUDE 14 FR.  DYND11214H",7905942,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH COUDE 14 FR. IN AND OUT URO3PVC1416",7905961,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH COUDE 16 FR.  DYND11216H",7905943,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATH COUDE 18 FR. DYND11218",7905948,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATH CRE BALLOON 5838-05",1750017,CDM,270,RC,,,OUTPATIENT,,,740,592,,629,85,,,,,0,"percent of total billed charges","85% of total billed charges",185,25,,,,,0,"percent of total billed charges","25% of total billed charges",185,25,,,,,0,"percent of total billed charges","25% of total billed charges",185,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",150.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",418.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",666,90,,,,,0,"percent of total billed charges","90% of total billed charges",259,35,,,,,0,"percent of total billed charges","35% of total billed charges",508.38,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",666,90,,,,,0,"percent of total billed charges","90% of total billed charges",429.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",150.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",629,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",150.74,666,
"CATH DELEE SUCT.",7905355,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATH DELEE SUCTION",7905357,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATH DUCANTO W/ 6 FR TUBING",7905451,CDM,270,RC,,,OUTPATIENT,,,32,25.6,,27.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",8,25,,,,,0,"percent of total billed charges","25% of total billed charges",8,25,,,,,0,"percent of total billed charges","25% of total billed charges",8,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",21.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.56,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.52,28.8,
"CATH DUCANTO W/ 6 FR TUBING 9.3 IN",7905452,CDM,270,RC,,,OUTPATIENT,,,32,25.6,,27.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",8,25,,,,,0,"percent of total billed charges","25% of total billed charges",8,25,,,,,0,"percent of total billed charges","25% of total billed charges",8,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",21.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.56,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.52,28.8,
"CATH FOLEY 10 FR. DYND11710",7905182,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY 12 FR. DYND11685P",7905187,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FOLEY 12 FR. DYND11752",7905221,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FOLEY 14 FR. 30CC DYND11774",7905220,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY 14 FR. DYND11659P",7905191,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FOLEY 16 FR. 30CC DYND11776",7905189,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY 24 FR. 30CC DYND11784",7905195,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY 6 FR. DYND11706",7905181,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY ALL SIZE",7905184,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CATH FOLEY IRR 16FR 30CC 3-WAY DYND11800",7905197,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY IRR. 3-WAY 18FR DYND11801",7905310,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"CATH FOLEY IRR. 3-WAY DYND11802",7905186,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY IRR. 3-WAY DYND11803",7905199,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY IRR. 3-WAY DYND11804",7905200,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH FOLEY IRR. 3-WAY DYND11805",7905252,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"CATH FOLEY SILASTIC",7905185,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CATH FREEDOM CLEAR 23 MM",7905131,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FREEDOM CLEAR 28 MM",7905132,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FREEDOM CLEAR 35 MM",7905133,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FREEDOM LARGE 35 MM 8400/8430",7905130,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FREEDOM MED 31 MM 8205/8235",7905129,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH FREEDOM SMALL 28 MM 8200/8230",7905128,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH INTRAN PLUS IUP-400",7905779,CDM,270,RC,,,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"CATH KIT CENTRAL MULTI CDC-42703-XP1A 16",7905495,CDM,270,RC,,,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,630,
"CATH KIT CENTRAL VENOUS AK-12703-CDC",7905499,CDM,270,RC,,,OUTPATIENT,,,375,300,,318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",131.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",257.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",217.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.39,337.5,
"CATH KIT CENTRAL VENOUS AK15703",7905498,CDM,270,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"CATH KIT CENTRAL VENOUS CDC-45703-P1A",7905496,CDM,270,RC,,,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,630,
"CATH KIT CENTRAL VENOUS C-PMS-631J",7905497,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"CATH KIT COMPLETE CDC-42703-XPCN1A AGB",7905611,CDM,270,RC,,,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,630,
"CATH KIT FEMALE",7905868,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH KIT INFANT 5FR 0035630",7905873,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH KIT MIDLINE ARROWG 4.5 FRX15CM",7905519,CDM,270,RC,,,OUTPATIENT,,,1450,1160,,1232.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",362.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",362.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",295.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1305,90,,,,,0,"percent of total billed charges","90% of total billed charges",507.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",996.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1305,90,,,,,0,"percent of total billed charges","90% of total billed charges",841,58,,,,,0,"percent of total billed charges","58% of total billed charges",295.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1232.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",295.37,1305,
"CATH KIT MULTI COM 16CM CDC-42707-XPCN1A",7905612,CDM,270,RC,,,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,630,
"CATH KIT PED FOLEY 10 FR TEMP SENSE 3ML",7905879,CDM,270,RC,,,OUTPATIENT,,,52.1,41.68,,44.29,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.03,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.03,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.03,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",29.44,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",29.44,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",29.44,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",29.44,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.89,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.24,35,,,,,0,"percent of total billed charges","35% of total billed charges",35.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.89,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.22,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",44.29,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.61,46.89,
"CATH KIT PED FOLEY 6 FR TEMP SENSE 3ML",7905878,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"CATH KIT PED FOLEY 8 FR TEMP SENSE 3ML",7905877,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"CATH KIT PEDI 8 FR",7905875,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH KIT PUREWICK FEMALE EXTERNAL",7905872,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH KIT PUREWICK MALE EXTERNAL",7905874,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CATH LEG STRAP",7905988,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH LEG STRAP DYND16800",7905989,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH MALECOT 20 FR. 361220",7905190,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CATH MALECOT 34 FR. 361234",7905177,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CATH NASAL 1527031",7950101,CDM,270,RC,,,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.53,616.5,
"CATH PED FOLEY",7950163,CDM,270,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"CATH PED. FOLEY 6 FR.",7905953,CDM,270,RC,,,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"CATH PED. FOLEY 8 FR.",7905871,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATH PLUG 1600",7905429,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH RED RUBBER 10 FR DYND13510",7905490,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH RED RUBBER 12 FR DYND13512",7905491,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH RED RUBBER 14 FR. DYND13514H",7905488,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH RED RUBBER ROBINSON 10 FR.",7905483,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH RED RUBBER ROBINSON 14 FR. 660143",7905485,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH SUCTION T60C",7905711,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH TEXAS",7905198,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH TRAY 14 FR.",7905196,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATH TRAY 14 FR. 771114",7905224,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH TRAY 14 FR. DYND10400",7905382,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH TRAY 14 FR. DYND10500",7905176,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATH TRAY 16 FR. 3716",7905227,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. 6014",7905301,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. 6140",7905299,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. 6946",7905309,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CATH TRAY 16 FR. 897216",7905229,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"CATH TRAY 16 FR. 897516",7905222,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. 899916",7905293,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. 947316",7905295,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. A947316",7905305,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. DYND11519",7905179,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 16 FR. DYND11523",7905244,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 18 FR.",7905180,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 18 FR. 6210",7905300,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 18 FR. 800362",7905258,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH TRAY 18 FR. 897518",7905223,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 18 FR. 899918",7905294,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 18 FR. 947318",7905297,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY 18 FR. A304718A",7905379,CDM,270,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"CATH TRAY 18 FR. DYND11528",7905241,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY SURESTEP 14 FR",7905350,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CATH TRAY SURESTEP 16 FR TEMP SENSE",7905351,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"CATH URETHERAL A/SZ",7905183,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATHETER COUDE TIP VINYL 12 FR MEDLINE",7905888,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATHETER COUDE TIP VINYL 16 FR MEDLINE",7905890,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CATHETER COUDE TIP VINYL 18 FR MEDLINE",7905891,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CAUTERY SURGICAL 55401",7905778,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CAUTERY SURGICAL AA01",7905787,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CAUTERY SURGICAL ESCT001",7905784,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CENTRAL LINE DRESSING KIT DYND74661",7950035,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CENTRAL LINE DRESSING KIT DYNJ03033",7950036,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CHEST TRAY",7905993,CDM,270,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"CHEST TUBE INSERTION TRAY MNS2250",7950340,CDM,270,RC,,,OUTPATIENT,,,190,152,,161.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",171,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",130.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",171,90,,,,,0,"percent of total billed charges","90% of total billed charges",110.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",161.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,171,
"CHEST TUBE TRY THAL QUICK",7950198,CDM,270,RC,,,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,868.5,
"CHEST TUBE TRY THAL QUICK",7950199,CDM,270,RC,,,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,868.5,
"CHLORAPREP 26 ML APPLICATOR",7905807,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CHLORAPREP 26 ML APPLICATOR 930815",7905810,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CIRCUIT ANESTTHESIA MEDLINE LF W/ MASK",7950372,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CIRCUMCISION SET",7901208,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CO2 DETECTOR EASYCAP II",7915429,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CO2 DETECTOR PEDICAP II",7915430,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CO2 SAMPLING LINE CAPNOLINE",7919146,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"COBAN 2",7950018,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 3",7950136,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 3  CARDINAL",7950111,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 4",7950130,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 4  STERILE",7905793,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 4  STERILE 2084S",7905789,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 6",7950131,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"COBAN 6  STERILE",7905933,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COBAN 6  STERILE 2086S",7905791,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COFLEX BANDAGE 1.5",7950025,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COFLEX BANDAGE 2",7950026,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COHESIVE BANDAGE 2",7950017,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COHESIVE BANDAGE 3",7950049,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COHESIVE BANDAGE 4 X 5 YD",7950054,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COHESIVE BANDAGE 6 X 5 YD",7950051,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COLOSTOMY POUCH 401515",7950094,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COLOSTOMY WAFER 401906",7950095,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CONFORM 4",7905705,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CONFORM 6",7905706,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CONTAINER EVACUATED GLASS 1000 ML",3050014,CDM,270,RC,,,OUTPATIENT,,,65.44,52.35,,55.62,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.36,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.36,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.36,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.97,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.97,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.97,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.97,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.9,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.96,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.62,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.33,58.9,
"CONTROL LVL 1 EUROTROL EPOC QC",1750085,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CONTROL LVL 3 EUROTROL EPOC QC",1750086,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"COPY FILM PER MRI/CT/US EXAM",4600803,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"COPY FILM PER X-RAY EXAM",4000803,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CORD MONOPOLOR HIGH FREQUENCY STORZ",7950399,CDM,270,RC,,,OUTPATIENT,,,800,640,,680,85,,,,,0,"percent of total billed charges","85% of total billed charges",200,25,,,,,0,"percent of total billed charges","25% of total billed charges",200,25,,,,,0,"percent of total billed charges","25% of total billed charges",200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",162.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",452,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",452,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",452,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",452,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",720,90,,,,,0,"percent of total billed charges","90% of total billed charges",280,35,,,,,0,"percent of total billed charges","35% of total billed charges",549.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",720,90,,,,,0,"percent of total billed charges","90% of total billed charges",464,58,,,,,0,"percent of total billed charges","58% of total billed charges",162.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",680,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",162.96,720,
"CORDBIP  FORCEPS E0509",7950174,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"COVER/POST-OP SPONGE",7905068,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CURAGEL DRESSINGS",7950118,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CURETTE ENDOMETRIAL SUCT.",7950028,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"CURETTE STERILE CURVED 7 MM",7905410,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CURETTE STERILE CURVED 8 MM",7905412,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CWV DRAIN 10 MM",7905740,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CWV DRAIN 7 MM",7905742,CDM,270,RC,,,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"CWV RESERVOIR",7905741,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CYSTO PACK IV",7905905,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CYTOLOGY BRUSH",7905912,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"D & C PACK",7901195,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"DEFIB ELECTRODES 31319281",7950117,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DEFIB ELECTRODES PEDIATRIC",7950052,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DEFIB ELECTRODES PEDIATRIC",7950132,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DEFIB PAD 2345N",7905743,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DEFIB PAD 2603M",7905745,CDM,270,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"DELIVERY RM PK III",7905568,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"DEMA WRAP 3IN",7950272,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DEMA WRAP 4IN",7950271,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DEMA WRAP LATEX FREE 2IN",7950273,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DERMABOND ADVANCED",2600554,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"DERMABOND TOPICAL MIS",2600552,CDM,270,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"DISP OXYHOOD",7919113,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"DRAIN CHEST OASIS DRY SUCTION",7905963,CDM,270,RC,,,OUTPATIENT,,,133,106.4,,113.05,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",75.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",75.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",75.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",75.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.55,35,,,,,0,"percent of total billed charges","35% of total billed charges",91.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",77.14,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",113.05,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.09,119.7,
"DRAIN SPONGE",7950211,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRAIN SPONGE IV 2 X 2",7950212,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRAIN SPONGE NON256000",7950218,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING ACTICOAT 7 4 X 5",7905439,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DRESSING ACTICOAT 7 6 X 6",7905440,CDM,270,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"DRESSING DUO-DERM 187660",7905436,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"DRESSING DUO-DERM 403332",7905437,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DRESSING DUODERM HYDROACTIVE GEL 30G",7950158,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING KALTOSTAT 168117",7905944,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DRESSING KENDALL FOAM 4 X 4",7950274,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING KENDALL FOAM ISLAND 4 X 4",7950275,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DRESSING MEPILEX 4 X 4",7950267,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DRESSING MEPILEX 6 X 6",7950264,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DRESSING MEPILEX 8 X 8",7905435,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"DRESSING MEPILEX BORDER 4 X 4",7950269,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DRESSING MEPILEX BORDER 6 X 6",7950270,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DRESSING MEPITEL 3 X 4",7905438,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DRESSING NON ADHERENT 2 X 3",7905104,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING NON ADHERENT 3 x 8",7905167,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING OPTIFOAM BORDER 6 X 6",7950292,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING SORBSAN",7905836,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"DRESSING SORBSAN 9347",7905863,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DRESSING TELFA 2 X 3",7905103,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TELFA 3 x 8",7905168,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TRANSPARENT FILM 2 3/8 X 2 3/4",7905396,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TRANSPARENT FILM 2.375 X 2.75",7905255,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TRANSPARENT FILM 2.375X2.75",7905107,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TRANSPARENT FILM 4 X 4.75",7905273,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TRANSPARENT SURESITE 123",7905256,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING TRANSPARENT TEGADERM 8X12",7905398,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING WET",7905408,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DURAPREP SOLUTION",7905808,CDM,270,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"EAR & ULCER SYRINGE 4172",7905232,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EAR & ULCER SYRINGE 44402",7905231,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EAR & ULCER SYRINGE DYND70280",7905230,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EAR & ULCER SYRINGE EAR502",7905112,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BAND 2  STER. 3112",7950230,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ELASTIC BAND 3  STER. 3113",7950268,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ELASTIC BAND 4  STER. 3114",7950210,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ELASTIC BAND 6  STER. REB3116",7950231,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 2  MDS055002",7905667,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 2  REB2002",7905666,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 3  MDS055003Z",7905139,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 3  REB2003",7905146,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 4  MDS055004",7905143,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 4  MDS057004",7905145,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 4  MDS077004Z",7905274,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 4  REB2004",7905144,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 6  MDS055006",7905142,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 6  MDS077006Z",7905306,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELASTIC BANDAGE 6  REB2006",7905141,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELECTRODE CLEAR TRACE 1700-005",7905571,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELECTRODE ECG LL110",7905859,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELECTRODE PED 01148592",7950156,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELECTRODE PEDIATRIC 224850",7950089,CDM,270,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"ELECTRODE PLIACELL 01-3830",7905562,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ELECTRODE RED DOT 2271-3 ADULT",7950008,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ELECTRODE SPIRAL 7000AAO",7950013,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"ENDO CLIP 5 mm",7950114,CDM,270,RC,,,OUTPATIENT,,,815,652,,692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",285.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",559.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,733.5,
"ENDO CLIP APPLIER EL5ML",7950146,CDM,270,RC,,,OUTPATIENT,,,265,212,,225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",92.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",182.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",153.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,238.5,
"ENDO GIA 30V STAPLER",7905845,CDM,270,RC,,,OUTPATIENT,,,1050,840,,892.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",262.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",262.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",262.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",213.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",593.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",593.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",593.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",593.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",945,90,,,,,0,"percent of total billed charges","90% of total billed charges",367.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",721.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",945,90,,,,,0,"percent of total billed charges","90% of total billed charges",609,58,,,,,0,"percent of total billed charges","58% of total billed charges",213.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",892.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",213.89,945,
"ENDO LIGACLIP AL326",7950155,CDM,270,RC,,,OUTPATIENT,,,815,652,,692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",285.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",559.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,733.5,
"ENDO RELOADS 35 MM",7950262,CDM,270,RC,,,OUTPATIENT,,,505,404,,429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",126.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",126.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",126.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",454.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",454.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",102.87,454.5,
"ENDOPATH ETS CUTTER",7950186,CDM,270,RC,,,OUTPATIENT,,,1100,880,,935,85,,,,,0,"percent of total billed charges","85% of total billed charges",275,25,,,,,0,"percent of total billed charges","25% of total billed charges",275,25,,,,,0,"percent of total billed charges","25% of total billed charges",275,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",224.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",385,35,,,,,0,"percent of total billed charges","35% of total billed charges",755.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",638,58,,,,,0,"percent of total billed charges","58% of total billed charges",224.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",935,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",224.07,990,
"ENDOPATH REDUCER CAPS",7950165,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"ENDOSCOPIC CLIP APPLIER",7950221,CDM,270,RC,,,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"ENDOSCOPIC STAPLER",7950124,CDM,270,RC,,,OUTPATIENT,,,1830,1464,,1555.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",457.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",457.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",457.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",372.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1033.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1033.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1033.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1033.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1647,90,,,,,0,"percent of total billed charges","90% of total billed charges",640.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1257.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1647,90,,,,,0,"percent of total billed charges","90% of total billed charges",1061.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",372.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1555.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",372.77,1647,
"EPIDURAL TRAY CE18HK",1805002,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"ET TUBE FASTENER ANCHOR",7915017,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ET TUBE GUIDE PED STYLETTE",7915019,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ET TUBE HOLDER",7915012,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ET TUBE HOLDER PEDIATRIC",7915013,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
ETHIODOL,4000036,CDM,270,RC,,,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,346.5,
"EXERCISER COACH 2 2500ML",5550053,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EXERCISER VOLUM AIRLIFE 2500ML 001903A",5550054,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EXERCISER VOLUM AIRLIFE 4000ML 001902A",5550038,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EXERCISER VOLUM VOLDYNE 5000 ML IS",5550005,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EXTENTION TUBE STOPCOCK",7905549,CDM,270,RC,L0120,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EXTRA VIEW OVAL SHAPE BALLOON AUTO SUTUR",7950133,CDM,270,RC,,,OUTPATIENT,,,1057.5,846,,898.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",264.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",264.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",264.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",215.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",597.49,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",597.49,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",597.49,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",597.49,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",951.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",370.13,35,,,,,0,"percent of total billed charges","35% of total billed charges",726.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",951.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",613.35,58,,,,,0,"percent of total billed charges","58% of total billed charges",215.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",898.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",215.41,951.75,
"EXTREMITY T-SHEET",7905567,CDM,270,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"EYE PAD",7905552,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EYE PAD NON21600Z",7905548,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EYE PROTECTOR FOAM STERILE",7905610,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"EYE PROTECTOR POSEY",7950088,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"EYE SHIELD",7905936,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"FEED TUBE 5 FR & 8 FR",7905484,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FEED TUBE 5 FR 260802",7950000,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FEED TUBE 5FR 155720",7950001,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FEED TUBE 5FR 460802",7950002,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FEED TUBE 8 FR ARGYLE",7950053,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FEED TUBE DOBBHOFF",7905919,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"FEED TUBE INFANT 8 FR",7905676,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"FILTERLINE SET",2092962,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"FILTERLINE SET 0683-00-0470-25",2092963,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"FLATUS BAG",7905235,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"FLOWTRON GARMENT",7905284,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"FLOWTRON GARMENT LG",7905286,CDM,270,RC,,,OUTPATIENT,,,61,48.8,,51.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",15.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",15.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",34.47,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",34.47,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",34.47,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",34.47,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.35,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",35.38,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.43,54.9,
"FLUTTER DEVICE MEDLINE RESP MUSCLE TRAIN",7915720,CDM,270,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"FLUTTER DEVICE SCA-910",7915710,CDM,270,RC,,,OUTPATIENT,,,540,432,,459,85,,,,,0,"percent of total billed charges","85% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",110,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",189,35,,,,,0,"percent of total billed charges","35% of total billed charges",370.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",110,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",459,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",110,486,
"GASTRIC LAVAGE KIT",7905245,CDM,270,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"GASTROINTESTINAL ANCHOR SET",7950204,CDM,270,RC,,,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,,,,0,"percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",114.07,504,
"GASTROSTOMY TUBE 000283",7950224,CDM,270,RC,,,OUTPATIENT,,,460,368,,391,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",161,35,,,,,0,"percent of total billed charges","35% of total billed charges",316.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",266.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",391,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",93.7,414,
"GASTROSTOMY TUBE 000287",7950209,CDM,270,RC,,,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",129.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",129.35,571.5,
"GASTROSTOMY TUBE CUBBY 35-2025",7950194,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2030",7950189,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2035",7950190,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2040",7950191,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2425",7950192,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2430",7950193,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2435",7950195,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2440",7950197,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE CUBBY 35-2445",7950200,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"GASTROSTOMY TUBE ENDOVIVE 20FR.",7950205,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"GASTROSTOMY TUBE ENDOVIVE 20FR. STD BALL",7950377,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"GASTROSTOMY TUBE MAGNA PORT 20FR",7950203,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"GASTROSTOMY TUBE MIC ADULT 22FR",7950201,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"GASTROSTOMY TUBE MIC ADULT 24FR",7950202,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"GASTROSTOMY TUBE MOSS 18 FR",7950329,CDM,270,RC,,,OUTPATIENT,,,1237,989.6,,1051.45,85,,,,,0,"percent of total billed charges","85% of total billed charges",309.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",309.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",309.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",698.91,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",698.91,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",698.91,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",698.91,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1113.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.95,35,,,,,0,"percent of total billed charges","35% of total billed charges",849.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1113.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",717.46,58,,,,,0,"percent of total billed charges","58% of total billed charges",251.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1051.45,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.98,1113.3,
"GAUZE FLUFF 36  X 18",7905528,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"GAUZE FLUFF SPONGE 6  X 6.75  10/TRAY",7905526,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GAUZE FLUFF SPONGE 6  X 6.75  5/TRAY",7905527,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLOVE COMPRESSION",5007118,CDM,270,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
"GRADUATE DISP.",7905242,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GRADUATE DISP. DYND80417",7905243,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GROUNDING PAD 607202002",7905563,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"GROUNDING PAD SURE FIT CON MED",7905876,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GROUNDING PAD XODUS 20240",7905869,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GROUNDING PAD/VALLEYLAB E7507",7905870,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GROUNDING PAD/VALLEYLAB E7507-DB",7905880,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GROUNDING PAD/VALLEYLAB INFANT E7510-25",7905479,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"HAND TRAY",7901202,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"HAND TROL 130309A",7905686,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"HAND TROL 130326A 15FT CORD",7905687,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"HEAD HALTER",7905248,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"HEANEY UTERINE CLAMP",7901213,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"HEAT AND MOISTURE EXCHANGER HME ADULT",5550046,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"HEEL PROTECTOR 7981007",7905250,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HEEL PROTECTOR M3014D6",7905249,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HEEL PROTECTOR MDT823280",7905247,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HEEL PROTECTOR MDT829280",7905246,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HIP KIT",7907160,CDM,270,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"HOLSTER ELECTROSURGICAL SAFETY",7905478,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"HUBER NEEDLE W/EXT 20GAX 1INCH",2611002,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"HUBER NEEDLE W/EXT 20GAX 3/4INCH",2611001,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"HUGGIES LARGE",7905265,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"HUGGIES MEDIUM",7905285,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HUGGIES SMALL",7905298,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"HUMIDIFICATION CHAMBER AH290",7950313,CDM,270,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
HYDRAGRAN,7905800,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
HYPERGEL,7950168,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"HYSTERO CATH. SET 5FR",4000806,CDM,270,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"HYSTERO TRAY",4000804,CDM,270,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"ICE BAG LARGE REFILLABLE W/TIES",7902006,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ICE BAG SMALL REFILLABLE W/TIES",7902005,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ICE PACK LARGE",7905178,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"ICE PACK SMALL 11400-100",7905253,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IMMOBILIZER SHOULDER MEDLINE XL",7905374,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"IMMOBILIZER SHOULDER UNIVERSAL",7905366,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"IMPLANT FH TOE",7905530,CDM,270,RC,,,OUTPATIENT,,,630,504,,535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",432.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.33,567,
"IMPLANT SMART PIN",7950126,CDM,270,RC,,,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,675,
"INTRODUCER BOUGIE 10 FR",7905973,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"INTRODUCER BOUGIE 15FR 9-0212-70",7905971,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"INTRODUCER SET 9 FR. 21-2340-24",7905966,CDM,270,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"INTRODUCER SET MICRO STICK 4FRX9CM",7905979,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"INTUBATION SET RETROGRADE",7905883,CDM,270,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"IRIS RETRACTOR",7950196,CDM,270,RC,,,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,589.5,
"IRRIG. SET/FOUR BAG",7950137,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"IRRIGATION TRAY",7905064,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IRRIGATION TRAY DYND20102",7905076,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IRRIGATION TRAY DYND20300 PISTON",7905078,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IRRIGATION TRAY DYND20302 PISTON",7905077,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ISOLATION SUPPLIES",1000011,CDM,270,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"IV BAG SPIKE CHEMOCLAVE",2613090,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV BLOOD SET MIS",2610512,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"IV BURETROL (IV VOLUMETRIC SET) MIS",2610059,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV CATH INTROCAN SAFETY 18 X 1 1/4 US",2673073,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH INTROCAN SAFETY 18 X 1-1/4 42545",2613081,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH INTROCAN SAFETY 18 X 2-1/2",2673072,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH INTROCAN SAFETY 22 X 1 425451102",2613083,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH INTROCAN SAFETY 24G 425351102",2613084,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH INTROCAN SAFETY 24GX3/4",2613089,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH. 18 X 1 1/4",2610529,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"IV CATH. 18 X 1 1/4 407500",2610528,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"IV CATH. 20 X 1",2613077,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"IV CATH. 22 X 1",2603070,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"IV CATH. 24 X 3/4",2613074,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH. 24 X 5/8",2613073,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"IV EXTENSION (IV MEDLOCK W/EXT) MIS",2610540,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV FILTER EXT .22MIC MIS",2610058,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV FILTER SET 1.2MIC MIS",2610054,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"IV MEDLOCK (PLUG) MIS",2610534,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"IV NITRO PUMP SET MIS",2610029,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV PED EXTENSION MIS",2610055,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV PRIMARY SET GRAVITY MIS",2610508,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV PROTECTED NEEDLE MIS",2610517,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV PROTECTOR HOUSE 727 SFP ULTRADOME",2610538,CDM,270,RC,,,OUTPATIENT,,,25.38,20.3,,21.57,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.35,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.35,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.84,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.88,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.84,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.72,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.57,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.17,22.84,
"IV PROTECTOR HOUSE 750 LFP ULTRADOME",2610537,CDM,270,RC,,,OUTPATIENT,,,25.38,20.3,,21.57,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.35,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.35,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.34,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.84,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.88,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.84,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.72,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.57,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.17,22.84,
"IV PUMP SET MIS",2610516,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV RATE FLOW MIS",2610521,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV SECONDARY LONG MIS0",2610507,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV SECONDARY SET MIS",2610509,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV SET ANESTHESIA MIS",2610070,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV SET SYRINGE PUMP MIS",2610069,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"IV VENTED ADAPTER MIS",2610057,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"KANGAROO (NUTRITION PUMP SET) MIS",2610536,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"KERLIX 2.5  6720",7905727,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KERLIX 4.5  6715",7905707,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KERLIX 4.5X4.1 YD   6730",7905731,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLING 2  STERILE",7901152,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLING 3  STERILE",7901153,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLING 4  STERILE",7901154,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLING STERILE 3  STRETCH 2232",7905697,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLING STERILE 4  STRETCH 2236",7905698,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLING STERILE 6  STRETCH 2238",7905699,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KNEE BRACE XXL",7905268,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"KNEE BRACE XXL BREG",7905395,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"KNEE IMMOBILIZER UNIVERSAL MEDLINE 12",7905975,CDM,270,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"KNEE IMMOBILIZER UNIVERSAL MEDLINE 14",7905949,CDM,270,RC,L1830,HCPCS,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.31,128.3,
"KNEE IMMOBILIZER UNIVERSAL MEDLINE 16",7905930,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"KNEE IMMOBILIZER UNIVERSAL MEDLINE 19",7905929,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"KNEE ORTHOSIS WRAP AROUND FRDM XXXL",7905287,CDM,270,RC,,,OUTPATIENT,,,265,212,,225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",92.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",182.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",153.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,238.5,
"KNEE SET",7901206,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"KNEE WRAP STABILIZER 929140",5007542,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"KOTEX/STAYFREE REG.",7905260,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LACERATION TRAY 05-5200",7950032,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"LACERATION TRAY BUSSE 4-1/2",7950048,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"LACERATION TRAY DYNJ03000",7950020,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"LACERATION TRAY DYNJ03108LF",7950034,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"LACERATION TRAY LAC1001",7950019,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"LAP IRRIGATOR",1570013,CDM,270,RC,,,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",199.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,513,
"LAP IRRIGATOR 0026870",7950085,CDM,270,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"LAP IRRIGATOR STRYKEFLOW 2 250-070-520",7950090,CDM,270,RC,,,OUTPATIENT,,,235,188,,199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",47.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",82.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",161.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",47.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",47.87,211.5,
"LAP PACK",7901193,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"LAP SPONGE 18 X 18",7905752,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LAP SPONGE 18 X 18  MDS251518LF",7905751,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LAP SPONGE 4 X 18",7905693,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"LARGE BONE SET",7901199,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"LECTROVAC II 10 FR FOOT",7905781,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"LECTROVAC II 12 FR",7905767,CDM,270,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"LENS INTRAOCULAR 14.5",1570104,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 15.0",1570105,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 16.5",1570108,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 17.0",1570109,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 17.5",1570110,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 18.5",1570112,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 19.0",1570113,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 24.0",1570140,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 25.5",1570151,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 26.0",1570155,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 26.5",1570156,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 28.0",1570166,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LENS INTRAOCULAR 29.0",1570168,CDM,270,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"LEVIN TUBE 14 FR. DYND70484",7905056,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEVIN TUBE 16 FR. DYND70486",7905057,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEVIN TUBE 18 FR. DYND70488",7905059,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEVINE TUBE 16 FR. 85753",7905055,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LEVINE TUBE 18 FR. 85754",7905065,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LEVINE TUBES 10FR",7905058,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LIGA CLIP ENDO ROTATING MCA",7950102,CDM,270,RC,,,OUTPATIENT,,,265,212,,225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",92.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",182.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",153.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,238.5,
"LIGATOR SHORTSHOT SAEED MULTI-BAND",1750016,CDM,270,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"LIGATOR SPEEDBAND SUPERVIEW SUPER 7",1750018,CDM,270,RC,,,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,868.5,
"LINEAR CUTTER 100 mm TLC10",7950228,CDM,270,RC,,,OUTPATIENT,,,765,612,,650.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",155.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",432.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",688.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",267.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",525.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",688.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",443.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",155.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",650.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",155.83,688.5,
"LMA DISPO",7905054,CDM,270,RC,,,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",107.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",107.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",107.96,477,
"LUMBAR PUN TRAY ADULT 648",7905422,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"LUMBAR PUN TRAY PED 4302CSP",7905415,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"LUMBAR PUN TRAY PED 4304C",7905417,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"LUMBAR PUN TRAY PED 645",7905421,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"LUMBAR PUN TRAY PED 945",7905414,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"LUMBAR PUNCTURE TRAY SPINA",7905416,CDM,270,RC,,,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"LUMBAR PUNCTURE TRAY SPINA 4301CSP",7905413,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"LUMBO SACRAL SUPPORT MED",7905775,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"LUMBO SACRAL SUPPORT SM",7905774,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"LUMBO SACRAL SUPPORT XL",7905777,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"LUMBO-SACRAL SUPPORT",7905267,CDM,270,RC,,,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,387,
"MAGSEED MARKER",2610527,CDM,270,RC,,,OUTPATIENT,,,2320,1856,,1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",580,25,,,,,0,"percent of total billed charges","25% of total billed charges",580,25,,,,,0,"percent of total billed charges","25% of total billed charges",580,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2088,90,,,,,0,"percent of total billed charges","90% of total billed charges",812,35,,,,,0,"percent of total billed charges","35% of total billed charges",1593.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2088,90,,,,,0,"percent of total billed charges","90% of total billed charges",1345.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.58,2088,
"MAGTRACE 2ML VIAL INJ",2610526,CDM,270,RC,,,OUTPATIENT,,,2965,2372,,2520.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",741.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",741.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",741.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",603.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1675.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1675.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1675.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1675.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2668.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1037.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2036.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2668.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1719.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",603.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2520.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",603.97,2668.5,
"MASK ANESTHESIA 1025",1805004,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK ANESTHESIA 1035",1805005,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK ANESTHESIA 1045",1805006,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK ANESTHESIA 1055",1805007,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK ANESTHESIA 1065",1805008,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK ANESTHESIA 1075",1805009,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK ANESTHESIA LARGE ADULT AM1000",1805030,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MASK INFANT MANUAL RESUS OXYGEN",7900010,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"MASK POM ELITE LARGE",1805032,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MASK PRM BREATHING CIRCUIT ADULT 72",7950357,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"MASK PROCEDURAL OXYGEN",1805029,CDM,270,RC,,,OUTPATIENT,,,33,26.4,,28.05,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",18.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",18.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.55,35,,,,,0,"percent of total billed charges","35% of total billed charges",22.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.14,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",28.05,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.72,29.7,
"MASTISOL UD VIAL MIS",2600550,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MATERNITY KIT",7905269,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MEDICOPASTE BANDAGE 4",7905721,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"MEPILEX DRESSING",7901626,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"MICRO WIRE DRIVER",7901181,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"MICROPUNCTURE ACCESS SET 5 FR",1750051,CDM,270,RC,,,OUTPATIENT,,,160,128,,136,85,,,,,0,"percent of total billed charges","85% of total billed charges",40,25,,,,,0,"percent of total billed charges","25% of total billed charges",40,25,,,,,0,"percent of total billed charges","25% of total billed charges",40,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",32.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",90.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",90.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",90.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",90.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",144,90,,,,,0,"percent of total billed charges","90% of total billed charges",56,35,,,,,0,"percent of total billed charges","35% of total billed charges",109.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",144,90,,,,,0,"percent of total billed charges","90% of total billed charges",92.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",136,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",32.59,144,
"MINI SPIKE 2N9106",2613080,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MOISTURE BARRIER",7905802,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MOISTURE BARRIER REMEDY ESSENTIALS 2OZ",7905803,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MONITORCENTRAL VENOUS",7905500,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"MORGAN TUBING",7905136,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"MU MONITOR/TELE",1093041,CDM,270,RC,,,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,387,
"MUCOUS TRAP 406",5550021,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MUCOUS TRAP DYND44110",5550030,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MUCOUS TRAP MST4000 40CC",5550052,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MYELOGRAM TRAY",4000805,CDM,270,RC,,,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,612,
"MYELOGRAM TRAY",7950235,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MYELOGRAM TRAY 956",7950236,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MYRINGOTOMY TRAY",7901541,CDM,270,RC,,,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,603,
"MYRINGOTOMY TUBE",7901018,CDM,270,RC,,,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"NASAL TRUMPET 28 FR",7919135,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"NASAL TRUMPET 30 FR",7919131,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"NASAL TRUMPET 30 FR MEDLINE",7919148,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"NASAL TRUMPET 32 FR",7919136,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"NASAL TRUMPET 32 FR MEDLINE ROBERTAZZI",7919147,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"NASAL TRUMPET 34 FR",7919137,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"NASAL TUBE FASTENER",7950176,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEBULIZER MICRO-MIST TUBING 1884 HUDSON",5550003,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEBULIZER MICRO-MIST TUBING HUD1884",5550045,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEBULIZER MINI HEART W/ADULT MASK 7IN TU",5550047,CDM,270,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"NEBULIZER MISTY MAX 002446",5550037,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEEDLE BIOPSY TRU-CUT 14 GA. X 4.5",7950248,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"NEEDLE BIOPSY TRU-CUT 14 GA. X 6",7950253,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"NEEDLE BIOPSY TRU-CUT 18 GA. X 6",7950252,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NEEDLE CATH CENTESIS",7950157,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"NEEDLE ELECTRODE",7905914,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NEEDLE MAT",7905694,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NEEDLE SADOWSKY",7950115,CDM,270,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"NEEDLE SPINAL 20GA X 6",4000808,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"NEEDLE SPINAL QUINCKE 405171 22 x 3",7950047,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEEDLE SPINAL QUINCKE 405184",7950043,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEEDLE WHITACRE 405010",7950029,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NEEDLE WHITACRE 405138",7950031,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NETI POT SINUCLEANSE STARTER KIT",7950023,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"NIPPLE SHIELD",7905292,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NM COLD PYP SOLUTION",4500029,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"NM PYP KIT",4500024,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NM VENTISCAN III",4500022,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"NON-REBREATHING MASK ADULT 001211U",7919111,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NON-REBREATHING MASK ADULT 1059",7919104,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NON-REBREATHING MASK ADULT HUD1059",7919121,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NON-REBREATHING MASK PED. HOSPITAK",7900004,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
NORMLGEL,7950173,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"NU-GAUZE 1  PLAIN 7633",7950217,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NU-GAUZE 1/2 PLAIN 7632",7950024,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NU-GAUZE 1/4  PLAIN 7631",7950219,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NU-GAUZE 2  PLAIN 7634",7950162,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NU-GAUZE PLAIN 1/4",7905066,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"O2 MASK ADULT 001201",7919108,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"O2 MASK ADULT 1041",7919102,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"O2 MASK ADULT 3 IN 1 STYLE 1361",7919123,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"O2 MASK ADULT AM-1000 AIRLIFE MED",7919143,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"O2 MASK ADULT HUDRHO41U",7919122,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"O2 MASK INFANT 1114-7-50",7919138,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"O2 MASK PEDIATRIC 001268U",7919139,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"O2 MASK PEDIATRIC 1042",7919100,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"O2 MASK PEDIATRIC 1130TG750",7919140,CDM,270,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"O2 NEBULIZER LARGE VOLUME 1770",5550016,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"O2 TUBING 001302",7919115,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"O2 TUBING 1115 HUDSON",7919119,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"O2 TUBING HUDSON",7919106,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"OB PAD STERILE",7905290,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OB/GYN PROCEDURE TRAY",4000807,CDM,270,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"OBTURATOR KII OPTICAL CTR01",1570790,CDM,270,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"OBTURATOR KII OPTICAL CTR03",1570084,CDM,270,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"OBTURATOR KII OPTICAL CTR71",1570791,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"OBTURATOR KII OPTICAL CTR73",1570085,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"OP SITE 10 X 5 1/2",7905897,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"OP SITE 11 X 11",7905809,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"OP SITE 2 X 3",7905262,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OP SITE 5 1/2 X 4",7905283,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OP SITE 5 1/2 X 4IN 4963",7905282,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OP SITE 6 X 6",7905766,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"OP SITE 6 X 8",7950039,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"OPTICAL DILATOR IN0216",1750005,CDM,270,RC,,,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",329,35,,,,,0,"percent of total billed charges","35% of total billed charges",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,846,
"OPTICAL DILATOR IN0218",1750006,CDM,270,RC,,,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",329,35,,,,,0,"percent of total billed charges","35% of total billed charges",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,846,
"OPTICAL DILATOR IN0220",1750007,CDM,270,RC,,,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",329,35,,,,,0,"percent of total billed charges","35% of total billed charges",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,846,
"OPTICHAMBER DIAMOND 1079830",5550039,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"OXIMETER SENSOR PED/INFANT/NEWBORN",7915416,CDM,270,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"OXIMETER SENSOR PULSE ADULT 18IN",7915411,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXIMETER SENSOR PULSE ADULT LNCS ADTX",7915410,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXIMETER SENSOR PULSE INFANT NONIN",7915414,CDM,270,RC,,,OUTPATIENT,,,46,36.8,,39.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",31.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.68,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",39.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.37,41.4,
"OXIMETER SENSOR PULSE LNCS INFANT",7915415,CDM,270,RC,,,OUTPATIENT,,,46,36.8,,39.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.99,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",31.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.68,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",39.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.37,41.4,
"OXIMETER SENSOR PULSE LNCS PED",7915413,CDM,270,RC,,,OUTPATIENT,,,48,38.4,,40.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,25,,,,,0,"percent of total billed charges","25% of total billed charges",12,25,,,,,0,"percent of total billed charges","25% of total billed charges",12,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",27.12,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",27.12,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",27.12,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",27.12,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",43.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.8,35,,,,,0,"percent of total billed charges","35% of total billed charges",32.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",43.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.84,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.78,43.2,
"OXIMETER SENSOR PULSE NEONATAL",7915409,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXIMETER SENSOR PULSE NEONATAL LNCS",7915405,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXIMETER SENSOR PULSE NEONATAL NONIN",7915412,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXIMETER SENSOR PULSE NEONATAL/ADULT",7915404,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXISENSOR N25",7915408,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OXYGEN PER HR",7919110,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
OXYGEN/HR,7915407,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"OXYHOOD 4000",7919109,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PAD HEAT THERAPY 13 X 18",7905974,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PAD HEAT THERAPY 15 X 22",7905939,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"PAD HEAT THERAPY 18 X 26",7905940,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PAD LEG PLATE 2464AAO",7905976,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PAPER BLUE COVER 8-1/2 X 11",5007530,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PARA-BLOC TRAY",7905296,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
PATHOLOGY/HANDLING,3200001,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"PEAK FLOWMETER 002068 CAREFUSION",5550040,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PEAK FLOWMETER 1801 HUDSON",5550018,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PEAK FLOWMETER HS750",5550017,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PEAK FLOWMETER HS756 LOW RANGE",5550042,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PEAK FLOWMETER TRUZONE",5550048,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
PEANUTS,7901050,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PEDIALYTE SOLUTION",2600156,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PEEP VALVE DISPOSABLE",7905594,CDM,270,RC,L0120,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PEG KIT CORFLO 305020",7905848,CDM,270,RC,,,OUTPATIENT,,,405,324,,344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",141.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",278.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,364.5,
"PENROSE DRAIN LATEX 1/4  20416-025",7950050,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PENROSE DRAIN LATEX 12X1/2",7950055,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"PENROSE DRAIN LATEX 18X 1/4 STERILE",7950056,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"PENROSE DRAIN LATEX FREE 1/2  DYND50428",7950005,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PENROSE DRAIN LATEX FREE 1/4  DYND50427",7950004,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PENROSE TUBING 1/4",7950014,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PENROSE TUBING 1/4  0912010",7950007,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PENROSE TUBING 3/4",7905464,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PENROSE TUBING 3953 1/4",7950037,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PERCUTANEOUS SHEATH INTRO KIT",7905680,CDM,270,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"PICC LINE KIT POWER PICC 4 FR 1 LUMEN",7905493,CDM,270,RC,,,OUTPATIENT,,,1039.9,831.92,,883.92,85,,,,,0,"percent of total billed charges","85% of total billed charges",259.98,25,,,,,0,"percent of total billed charges","25% of total billed charges",259.98,25,,,,,0,"percent of total billed charges","25% of total billed charges",259.98,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",587.54,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.54,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.54,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.54,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",935.91,90,,,,,0,"percent of total billed charges","90% of total billed charges",363.97,35,,,,,0,"percent of total billed charges","35% of total billed charges",714.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",935.91,90,,,,,0,"percent of total billed charges","90% of total billed charges",603.14,58,,,,,0,"percent of total billed charges","58% of total billed charges",211.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",883.92,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.83,935.91,
"PLATELET IV SET",2613079,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
PLEUR-EVAC,7905964,CDM,270,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"PNEUMOTHORAX KIT",7905663,CDM,270,RC,,,OUTPATIENT,,,588,470.4,,499.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",147,25,,,,,0,"percent of total billed charges","25% of total billed charges",147,25,,,,,0,"percent of total billed charges","25% of total billed charges",147,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",332.22,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",332.22,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",332.22,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",332.22,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",529.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",205.8,35,,,,,0,"percent of total billed charges","35% of total billed charges",403.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",529.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",341.04,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",499.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.78,529.2,
"PNEUMOTHORAX KIT 567032",7905668,CDM,270,RC,,,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,391.5,
"POLYP TRAP",7905051,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"POLYSKIN DRESSING 2 X 2-3/4",7905254,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"POST OP SHOE MENS LARGE",7905665,CDM,270,RC,A9270,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE MENS LARGE BREG",7905674,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE MENS MED",7905661,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE MENS MED BREG",7905673,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE MENS MED NYLON",7905672,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE MENS SMALL",7905660,CDM,270,RC,A9270,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE MENS XL",7905662,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE ORTHOWEDGE LARGE",7905670,CDM,270,RC,A9270,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"POST OP SHOE ORTHOWEDGE MED",7905669,CDM,270,RC,A9270,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"POST OP SHOE ORTHOWEDGE SMALL",7905671,CDM,270,RC,A9270,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"POST OP SHOE WOMENS MED",7905656,CDM,270,RC,A9270,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POST OP SHOE WOMENS SMALL",7905655,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POWER PORT HUBER NEEDLE 20GA X 0.75INCH",2611015,CDM,270,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POWER PORT HUBER NEEDLE 20GAX1.5 INCH",2611000,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"PREP TRAY",7901212,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"PROBE COVER GENERAL PURPOSE 5 X 48",1570795,CDM,270,RC,,,OUTPATIENT,,,15.5,12.4,,13.18,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.76,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.76,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.95,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.43,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.95,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.99,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.18,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.16,13.95,
"PROBE COVER GENERAL PURPOSE 5 X 96",1570794,CDM,270,RC,,,OUTPATIENT,,,47.09,37.67,,40.03,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.77,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.77,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.77,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",26.61,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",26.61,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",26.61,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",26.61,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.38,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.48,35,,,,,0,"percent of total billed charges","35% of total billed charges",32.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.38,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.31,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.03,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.59,42.38,
"PROBE COVER KIT 5 X 96 HALYARD",1570900,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PROBE COVER MICROTEK US INTRAOP 5 X 96",1570902,CDM,270,RC,,,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"PULMOGUARD PFT FILTER 29 7950 050",7907950,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PUTTY COLOR CHANGE C92519",7907178,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"RAPICIDE PA DISINFECTANT",1750070,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"RESTRAINT  VEST 3311M",7905311,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"RESTRAINT  VEST M228-M",7905312,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"RESTRAINT VEST CRISS CROSS M117M",7902004,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"RETRACTOR IRIS",7950006,CDM,270,RC,,,OUTPATIENT,,,1235,988,,1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",848.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",716.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.57,1111.5,
"RETRACTOR KIT REDD-SAYE",7905770,CDM,270,RC,,,OUTPATIENT,,,590,472,,501.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",147.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",147.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",147.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",120.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",531,90,,,,,0,"percent of total billed charges","90% of total billed charges",206.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",405.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",531,90,,,,,0,"percent of total billed charges","90% of total billed charges",342.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",120.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",501.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",120.18,531,
"RIB BELT FEMALE ALL",7905308,CDM,270,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"RING REMOVAL",7905073,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ROOM HUMIDIFIER",5550022,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"ROTH RET NET BX00711050",7905565,CDM,270,RC,,,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"RX INTERVENTION MIS",2699991,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"RX MONITOR MIS",2699992,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SAF-GEL 3 OZ.",7950175,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SALEM SUMP TUBE  6 FR.",7905070,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SALEM SUMP TUBE 10 FR.",7905079,CDM,270,RC,,,OUTPATIENT,,,19,15.2,,16.15,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",10.74,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.65,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.02,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",16.15,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.87,17.1,
"SALEM SUMP TUBE 12 FR.",7905067,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SALEM SUMP TUBE 14 FR.",7905069,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SALEM SUMP TUBE 14 FR.",7905080,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SALEM SUMP TUBE 16 FR.",7905063,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SALEM SUMP TUBE 18 FR.",7905062,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SIGMOID SUCTION SET",7905332,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SILASTIC DRAIN 7/16",7905075,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SNARE DISPO STERIS SHORT THROW OVAL",7905389,CDM,270,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"SNARE DISPOS MED OVAL STIFF M00561831",7905378,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SNARE DISPOSABLE 6240-40",7905164,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SNARE DISPOSABLE BX/5",7905289,CDM,270,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SNARE DISPOSABLE M00562673 BX/40",7905271,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SOS BAKRI TAMP BALLOON",7950229,CDM,270,RC,,,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",193.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",193.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",193.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.87,697.5,
"SPACE MAKER PRO COVIDIEN",7950134,CDM,270,RC,,,OUTPATIENT,,,1889,1511.2,,1605.65,85,,,,,0,"percent of total billed charges","85% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",384.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1700.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",661.15,35,,,,,0,"percent of total billed charges","35% of total billed charges",1297.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1700.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",1095.62,58,,,,,0,"percent of total billed charges","58% of total billed charges",384.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1605.65,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",384.79,1700.1,
"SPINAL ANES TRAY P25BK",1805001,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SPLINT ANTI-SPASTICITY BALL MED LEFT",5007120,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"SPLINT ANTI-SPASTICITY BALL MED RIGHT",5007121,CDM,270,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"SPLINT CONFORMABLE SYN 3  X FT",2005982,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SPLINT CONFORMABLE SYN 4  X FT",2005983,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SPLINT CONFORMABLE SYN 5  X FT",2005984,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT DOYLE NASAL 1524055",7905951,CDM,270,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"SPLINT ELBOW TENNIS",7905758,CDM,270,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"SPLINT FINGER 1 1/4 PLN END 7973212",7905329,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 2 1/4 PLN END 7973213",7905330,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 3 1/4 BALL END 7973215",7905323,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 3 1/4 PLN END 7973214",7905314,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 4 1/4 BALL END 7973216",7905324,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 5 1/4 BALL END 7973217",7905315,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 6 1/4 BALL END 7973218",7905325,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER 7 1/4 BALL END 7973219",7905326,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT FINGER ALL SZ",7905322,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPLINT GOLDSMITH NASAL",7905952,CDM,270,RC,,,OUTPATIENT,,,580,464,,493,85,,,,,0,"percent of total billed charges","85% of total billed charges",145,25,,,,,0,"percent of total billed charges","25% of total billed charges",145,25,,,,,0,"percent of total billed charges","25% of total billed charges",145,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",118.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",327.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",327.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",327.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",327.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",522,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,35,,,,,0,"percent of total billed charges","35% of total billed charges",398.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",522,90,,,,,0,"percent of total billed charges","90% of total billed charges",336.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",118.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",493,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",118.15,522,
"SPLINT LONG ARM W/RDIAL BAR TAILOR",5007543,CDM,270,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SPLINT POSTERIOR LEAF C7826-02",5007123,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"SPLINT SAMMONS PRESTON HUMERUS",7900501,CDM,270,RC,,,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.53,616.5,
"SPLINT SYN 3  X FT",2005985,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SPLINT SYN 4  X FT",2005986,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT SYN 5  X FT",2005987,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT SYN 6  X FT",2005988,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT THUMBKEEPER UNIVERSAL",7907174,CDM,270,RC,,,OUTPATIENT,,,43,34.4,,36.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.05,35,,,,,0,"percent of total billed charges","35% of total billed charges",29.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.76,38.7,
"SPLINT THUMBKEEPER/592X",7907172,CDM,270,RC,,,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"SPLINT TOE ALL SIZE",7907530,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SPLINT WRIST D-RING A607XX",7907980,CDM,270,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"SPLINT WRIST MED RT (FIT/ADJ)",7905203,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SPLINT WRIST MED RT LOOP CLOSE RIGHT",7905359,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SPLINT WRIST PED/XS RIGHT (FIT/ADJUST)",7905212,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SPLINT WRIST PED/XS RIGHT 8  MEDLINE",7905376,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SPLINT WRIST UNIVERSAL RT MEDLINE",7905361,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SPLINT WRIST UNIVERSAL RT MEDLINE XL",7905362,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"SPLINT WRIST XL LT (FIT/ADJ)",7905210,CDM,270,RC,L3908,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SPONGES PEANUT",7905234,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SPONGES PEANUT 30-106",7905236,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPONGES PEANUT DMA74712",7905233,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STAPLE REMOVAL TRAY 772",7950216,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STAPLE REMOVER SKIN DYNJ04058Z",7905846,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STAPLE REMOVER SKIN DYNJ04059",7905850,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STAPLER CIRCULAR CURVED 29mm",7950122,CDM,270,RC,,,OUTPATIENT,,,1805,1444,,1534.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",367.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1624.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",631.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1240.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1624.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1046.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",367.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1534.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",367.68,1624.5,
"STAPLER LOADING UNIT",7950119,CDM,270,RC,,,OUTPATIENT,,,1045,836,,888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",261.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",261.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",261.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",717.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",606.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",212.87,940.5,
"STAPLER LOADING UNIT TA6035L",7950293,CDM,270,RC,,,OUTPATIENT,,,805,644,,684.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",201.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",201.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",201.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",163.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",454.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",454.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",454.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",454.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",724.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",281.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",553.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",724.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",466.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",163.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",684.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",163.98,724.5,
"STAT LOCK FOLEY STABLIZATION DEVICE",7905377,CDM,270,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"STAT LOCK PICC PLUS STABLIZATION BU",7905380,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"STAT LOCK PICC PLUS STABLIZATION DEVICE",7905352,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"STOMA MEASURING DEVICE 315555",7905849,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"STOMACH EVACUATOR TUBE",7905118,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"STYLET INTUBATING 2.5 MM-4.5 MM",7905358,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STYLET INTUBATING 502501",7905239,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STYLET INTUBATING 502507",7905238,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STYLET INTUBATING 85863",7905317,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"STYLET INTUBATING 85865",7905240,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUCTION  ABD",7901120,CDM,270,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SUCTION CANISTER 1200 CC  485410",7915701,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUCTION CANISTER 1200 CC  65651-212",7915709,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CANISTER 1200 CC  65651-395",7915717,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CANISTER 1200CC  713004",7915708,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CANISTER 1200CC  MEDLINE W/ TUBE",7915723,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CANISTER 1200CC  PHER1200B",7915722,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CANISTER 2500CC 711107",7905343,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CANISTER 3000 CC  65651-230",7915716,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION COAGULATOR E3310",7905782,CDM,270,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SUCTION CONNECTOR",7915001,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUCTION TUBING 72",7915704,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUPERPUBIC SET",7905885,CDM,270,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,661.5,
"SURE-CLOSE WOUND CLOSURE",2600553,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"SURGICAL SUCTION POOLE DYND50172",7905689,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SURGICAL SUCTION TUBE 35050",7905688,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SURGICAL TIP CLEANER",7905918,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SURGICLIP II",7950140,CDM,270,RC,,,OUTPATIENT,,,540,432,,459,85,,,,,0,"percent of total billed charges","85% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",110,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",189,35,,,,,0,"percent of total billed charges","35% of total billed charges",370.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",110,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",459,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",110,486,
"SUSPENSORY LG",7905344,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUSPENSORY LG W/LEG STRAPS 201255",7905349,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUSPENSORY LG W/O LEG STRAPS 0911-03",7905368,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUSPENSORY LG W/O LEG STRAPS 202430",7905347,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUSPENSORY MED",7905342,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUSPENSORY MED W/LEG STRAPS 201161",7905346,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUSPENSORY SM",7905341,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUSPENSORY XL W/LEG STRAPS 201352",7905348,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUSPENSORY X-LG",7905345,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SWEET EASE SUCROSE SOLN",7905151,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SWIVEL ADAPTORS",7919210,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SYRINGE GAUGE ASSEMBLY 5060-05",7950227,CDM,270,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"T & A PACK",7901196,CDM,270,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"T ADAPTER",7915557,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"TENT FACE W/TUBING",5550007,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"THERABAND BLACK",5007128,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"THERABAND BLUE",5007127,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"THERABAND GREEN",5007126,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"THERABAND RED",5007125,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"THERABAND SILVER",5007129,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"THERABAND YELLOW",5007124,CDM,270,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"THERAPUTTY 2 OZ.",7905664,CDM,270,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"THORACENTESIS KIT",7905678,CDM,270,RC,,,OUTPATIENT,,,280,224,,238,85,,,,,0,"percent of total billed charges","85% of total billed charges",70,25,,,,,0,"percent of total billed charges","25% of total billed charges",70,25,,,,,0,"percent of total billed charges","25% of total billed charges",70,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",98,35,,,,,0,"percent of total billed charges","35% of total billed charges",192.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,252,
"THORACENTESIS KIT 30-CE1CO",7905679,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"THORACENTESIS TRAY",7905363,CDM,270,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"THORACENTESIS TRAY TPT1000",7905397,CDM,270,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"THUMB SPLINT VT51700",5007122,CDM,270,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"TLS DRAIN",7950222,CDM,270,RC,,,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,,,,0,"percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,288,
"TONSIL SPONGE",7905724,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TOWEL DISPO OR",7905935,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TOWEL DISPO OR MEDICAL ACTION",7905931,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TOWEL OR COTTON STERILE",7905932,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACH CLEANING KIT",7915003,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACH MASK 001225",7919204,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACH MASK 1075 HUDSON",7919203,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 2.5 86222 UNCUFFED",7905538,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 2.5 NEF SHILEY UNCUFFED",7905604,CDM,270,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"TRACHEAL TUBE 3.0 86223",7905539,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 3.0 86234",7905535,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 3.0 86442",7905540,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 3.0 PELF SHILEY UNCUFFED",7905603,CDM,270,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"TRACHEAL TUBE 3.5 86224 UNCUFFED",7905546,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 3.5 86235 UNCUFFED",7905598,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 3.5 86443",7905560,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 4.0 CUFFED 86444",7905561,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 4.0 NASAL RAE 86285",7905730,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEAL TUBE 4.0 UNCUFFED 86225",7905536,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 4.5 CUFFED 86445",7905557,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 4.5 NASAL RAE 86286",7905729,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEAL TUBE 4.5 UNCUFFED 86226",7905551,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 5.0 86107",7905558,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 5.0 NASAL RAE 86287",7905728,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEAL TUBE 5.0 PEF SHILEY UNCUFFED",7905605,CDM,270,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"TRACHEAL TUBE 5.0 UNCUFFED 86227",7905544,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 5.5 86108",7905559,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 5.5 NASAL RAE 86288",7905541,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEAL TUBE 5.5 ORAL RAE 86201",7905735,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 6.0 86109",7905564,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 6.0 NASAL RAE 86212",7905542,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 6.0 ORAL RAE 86202",7905734,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 6.0 PELF SHILEY UNCUFFED",7905602,CDM,270,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"TRACHEAL TUBE 6.5 86110",7905556,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 6.5 NASAL RAE 86213",7905543,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 6.5 ORAL RAE 86203",7905733,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 7.0 NASAL RAE 86214",7905659,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 7.5",7905555,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 7.5 ENDO TRACH TUBE",7905634,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEAL TUBE 7.5 HI LOW ENDO",7905613,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 7.5 NASAL RAE 86215",7905658,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRACHEAL TUBE 8.0",7905553,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 8.0 INTERMD",7905606,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 8.5",7905566,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 8.5 SHILEY UNCUFFED",7905595,CDM,270,RC,,,OUTPATIENT,,,300,240,,255,85,,,,,0,"percent of total billed charges","85% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",105,35,,,,,0,"percent of total billed charges","35% of total billed charges",206.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",174,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",255,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,270,
"TRACHEAL TUBE 9.0",7905570,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE ORAL",7905736,CDM,270,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"TRACHEOSTOMY TUBE HOLDER",7950127,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRANSPEC PERFORATED COMPRESSION PLATE",6000362,CDM,270,RC,,,OUTPATIENT,,,157.05,125.64,,133.49,85,,,,,0,"percent of total billed charges","85% of total billed charges",39.26,25,,,,,0,"percent of total billed charges","25% of total billed charges",39.26,25,,,,,0,"percent of total billed charges","25% of total billed charges",39.26,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",88.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",141.35,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.97,35,,,,,0,"percent of total billed charges","35% of total billed charges",107.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",141.35,90,,,,,0,"percent of total billed charges","90% of total billed charges",91.09,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",133.49,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.99,141.35,
"TRAY DRAINAGE AND INCISION COMFORT LOOP",7919134,CDM,270,RC,,,OUTPATIENT,,,12,9.6,,10.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",3,25,,,,,0,"percent of total billed charges","25% of total billed charges",3,25,,,,,0,"percent of total billed charges","25% of total billed charges",3,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",8.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.96,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.44,10.8,
"TROCAR 12 MM 512B",7950169,CDM,270,RC,,,OUTPATIENT,,,905,724,,769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",621.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",524.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,814.5,
"TROCAR BLADELESS 35NLT",7950261,CDM,270,RC,,,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,,,,0,"percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,576,
"TROCAR BLUNT TIP OMST12BT",7950121,CDM,270,RC,,,OUTPATIENT,,,1215,972,,1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",303.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",303.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",303.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1093.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",425.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",834.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1093.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",704.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",247.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,1093.5,
"TROCAR ENDOPATH",7950164,CDM,270,RC,,,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,675,
"TROCAR KII BLUNT TIP C0R50",1570087,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"TROCAR KII BLUNT TIP C0R85",1570083,CDM,270,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"TROCAR X-CEL 5MM B5LT",7950259,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"TROCAR XCEL BLADELESS B11LT",7950266,CDM,270,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"TROCAR XCEL BLADELESS B12LT",7950260,CDM,270,RC,,,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,670.5,
"TROCAR XCEL BLUNT TIP H12LP",7950263,CDM,270,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"TROCAR XCEL DILATING TIP D5LT",7950265,CDM,270,RC,,,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,670.5,
"TROCAR/ENDOPATH 5MM 355LD",7950141,CDM,270,RC,,,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"TUBE DUAL LUMEN SUMP 8 FR",7905726,CDM,270,RC,,,OUTPATIENT,,,20.25,16.2,,17.21,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.06,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.06,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.06,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.44,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.44,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.44,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.44,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.23,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.09,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.23,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.75,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.21,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.12,18.23,
"TUBE EAR RUBE VENTILATION",7905773,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"TUBE EAR SHEEHY VENTILATION",7905768,CDM,270,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"TUBING CONNECTOR 6FT ST2001",7905725,CDM,270,RC,,,OUTPATIENT,,,8,6.4,,6.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",2,25,,,,,0,"percent of total billed charges","25% of total billed charges",2,25,,,,,0,"percent of total billed charges","25% of total billed charges",2,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4.52,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",4.52,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",4.52,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",4.52,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.8,35,,,,,0,"percent of total billed charges","35% of total billed charges",5.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.64,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.63,7.2,
"TUBING CORRUGATED 001410",5550019,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TUBING CORRUGATED 1418",7919206,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TUBING CORRUGATED HSK626",7919207,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TUBING FUNNEL 18IN",7905720,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TUBING INSUFFLATION",7950086,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"TUBING LAPROSCOPIC INSUFFLATION 031210-1",7950084,CDM,270,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"TUBING NONCONDUCTIVE MEDLINE",7905714,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"TUBING NONCONDUCTIVE N512",7905718,CDM,270,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"TUBING NONCONDUCTIVE N56A",7905814,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"TUBING NONCONDUCTIVE N66A",7905713,CDM,270,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"TUBING NONCONDUCTIVE OR512",7905717,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TUBING NONCONDUCTIVE ST1003",7905719,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TUBING UTERINE ASPIRATING 00153",7905409,CDM,270,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"TWISTER POLYP RETRIEVAL DEVICE",7905545,CDM,270,RC,,,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"UNDERPAD  30 X 36 DRY PREMIUM",7905747,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNDERPAD  30 X 36 EXTRASORB MSC8003003",7905746,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNDERPAD EXTRABULK3036",7905748,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNDERPAD ULTRASORB EXTRASORB3036A",7905761,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNDERPAD ULTRASORB EXTSB3036A350",7905788,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNDERPAD WINGS QUILTED 30 X 36",7905757,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNIVERSAL ANESTHESIA SET 2C9218",1805000,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"URINARY DRAINAGE BAG 6208",7905384,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"URINARY DRAINAGE BAG DYND15205",7905385,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"URINARY DRAINAGE BAG O.R. STER DYND15210",7905386,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"URINE COLL (PED)STERILE",7905375,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"URINE LEG BAG",7905060,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"URINE LEG BAG LB0019",7905061,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"URINE METER",7905980,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"URINE STRAINER",7905119,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"URINE STRAINER DYND4712",7905120,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UTERINE MANIPULATOR",7950116,CDM,270,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"VACUUM CUP 003CB",7905537,CDM,270,RC,,,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"VACUUM CUP 004CB",7905096,CDM,270,RC,,,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,,,,0,"percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,288,
"VAGINAL IRRIG SET",7905390,CDM,270,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"VAGINAL SPEC DISPO VAG1001 (SM)",7905392,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VAGINAL SPEC DISPO VAG1002 (MED)",7905393,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VAGINAL SPEC DISPO VAG1003 (LG)",7905394,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VAGINAL SPECULUM ER SPEC LIGHT (LG)",7905928,CDM,270,RC,,,OUTPATIENT,,,16,12.8,,13.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.6,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.28,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.26,14.4,
"VAGINAL SPECULUM ER SPEC LIGHT (MED)",7905927,CDM,270,RC,,,OUTPATIENT,,,16,12.8,,13.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.6,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.28,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.26,14.4,
"VAGINAL SPECULUM ER SPEC LIGHT (SM)",7905926,CDM,270,RC,,,OUTPATIENT,,,16,12.8,,13.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",4,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9.04,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.6,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.28,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.26,14.4,
"VAGINAL SPECULUM/LIGHT (SM)",7905922,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VAGINAL SPECULUM/SHEATH (MED)",7905920,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VAGINAL SPECULUM/SHEATH (SM)",7905921,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"VALVE ADULT LOPEZ",7905591,CDM,270,RC,L0120,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VALVE SALEM SUMP ANTI REFLUX",7905592,CDM,270,RC,L0120,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"VENT CIRCUIT PB 72 IN 001793",7950331,CDM,270,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"VENTURI MASK ADULT 001255",7919155,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VENTURI MASK ADULT 1088",7919105,CDM,270,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"VENTURI MASK PED",7900003,CDM,270,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"VIBRAPEP OSCILLATORY",7915714,CDM,270,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"VIBRAPEP OSCILLATORY NO T PIECE",7915721,CDM,270,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"VITRECTOMY PAK",7950234,CDM,270,RC,,,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,603,
"WALKER BRACE LEG STANDARD TALL MEDLINE M",7905901,CDM,270,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"WALKER TRACKER EX LARGE DEROYAL",7905904,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"WALKER TRACKER EX MEDIUM DEROYAL",7905903,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"WALKER TRACKER SMALL DEROYAL",7905958,CDM,270,RC,L4387,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"WATER DIST (1 GAL)",7915426,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"WATER TRAP",7915558,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"WEBRIL 3 IN ROLL/STR",7901141,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"WEBRIL 4 IN ROLL/STR",7901142,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"WEBRIL 6 IN ROLL/STR",7901143,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
WHIT,7950232,CDM,270,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"XR SIALOGRAPHY SET",4070391,CDM,270,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"YANKAUER SUCT HANDLE 10FT DYND50138",7905419,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"YANKAUER SUCT HANDLE 6FT DYND50135",7905418,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"YANKAUER SUCT HANDLE K83A",7905411,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"YANKAUER SUCTION 505016",7915706,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"YANKAUER SUCTION DYND50130",7915715,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"YANKAUER SUCTION K86",7915713,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"YANKAUER SUCTION YANK1001",7915707,CDM,270,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"YANKAUERS SUCTION 40600",7915703,CDM,270,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SALINE MEDLOCK (SOD CHL 0.9%) INJ 10ML",2601321,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"AIRWAY I GEL SIZE 2 SUPRAGLOTTIC",1805031,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"AIRWAY I GEL SIZE 3 SUPRAGLOTTIC",1805027,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"AIRWAY I GEL SIZE 4 SUPRAGLOTTIC",1805028,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"AIRWAY LMA 1 M0342",1805024,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA 1-1/2 M0352",1805025,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA 2 M0362",1805026,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA 2.5 M0372",1805015,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA 3 M0312",1805016,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA 4 M0322",1805017,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA 5 M0332",1805018,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA SUPREME 2.5",1805011,CDM,272,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"AIRWAY LMA SUPREME 3",1805012,CDM,272,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"AIRWAY LMA SUPREME 4",1805013,CDM,272,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"AIRWAY LMA SUPREME 5",1805014,CDM,272,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"AIRWAY LMA UNIQUE SURE SIZE 1",1805019,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA UNIQUE SURE SIZE 2",1805020,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA UNIQUE SURE SIZE 3",1805021,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA UNIQUE SURE SIZE 4",1805022,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"AIRWAY LMA UNIQUE SURE SIZE 5",1805023,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ALEXIS O WOUND PROTECT RETRACT 2.5-6CM",1570081,CDM,272,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"ALEXIS O WOUND PROTECT RETRACT 5-9CM",1570082,CDM,272,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"ALLDRESS 4 X 4",7950255,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"APOLLO RF 50DEG MULTIPORT ABLATOR",1570825,CDM,272,RC,,,OUTPATIENT,,,975,780,,828.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",198.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",550.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",550.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",550.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",550.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",877.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",341.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",669.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",877.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",565.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",198.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",828.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",198.61,877.5,
"APOLLO RF 90DEG MULTIPORT ABLATOR",1570824,CDM,272,RC,,,OUTPATIENT,,,935,748,,794.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",233.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",233.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",233.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",190.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",528.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",528.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",528.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",528.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",841.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",327.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",642.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",841.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",542.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",190.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",794.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",190.46,841.5,
"APPLICATOR ENDOSCOPIC",7905102,CDM,272,RC,,,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,301.5,
"ARISTA AH 3 G",7905105,CDM,272,RC,,,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,855,
"ARISTA AH FLEXTIP XL APPLICATOR",7905106,CDM,272,RC,,,OUTPATIENT,,,92,73.6,,78.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",23,25,,,,,0,"percent of total billed charges","25% of total billed charges",23,25,,,,,0,"percent of total billed charges","25% of total billed charges",23,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",51.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",51.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",51.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",51.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",63.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",53.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",78.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.74,82.8,
"ARTERIAL BLOOD GAS KIT 4599P 1",7904599,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ARTERIAL BLOOD GAS KIT PEDS 4619P-2",7904600,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ARTHROSCOPIC CUTTER",7905712,CDM,272,RC,,,OUTPATIENT,,,715,572,,607.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",178.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",178.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",178.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",145.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",643.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",250.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",491.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",643.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",414.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",145.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",607.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",145.65,643.5,
"ARTHROSCOPIC CUTTER",7905851,CDM,272,RC,,,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",196.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",274.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",159.9,706.5,
"BIOPSY CHIBA NEEDLE",4000801,CDM,272,RC,,,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"BIOPSY INSTRUMENT MAX CORE MC1410",7950295,CDM,272,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"BIOPSY INSTRUMENT MAX CORE MC1416",7950243,CDM,272,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"BIOPSY INSTRUMENT MAX CORE MN1416",7950402,CDM,272,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"BIOPSY INSTRUMENT MONOPTY 121410",7950206,CDM,272,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BIOPSY PROBE MAMMOTOME ELITE",7950308,CDM,272,RC,,,OUTPATIENT,,,970,776,,824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",242.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",242.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",242.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",197.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",873,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",666.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",873,90,,,,,0,"percent of total billed charges","90% of total billed charges",562.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",197.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",197.59,873,
"BIOPSY PUNCH DERMAL 3 MM",7950390,CDM,272,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"BIOPSY PUNCH DERMAL 4 MM",7950334,CDM,272,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"BIPAP CAP MASK LARGE 1061729",7900018,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",120,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.8,120,
"BIPAP CAP MASK LARGE 1072629",7900023,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK LARGE 73-1019480EA",7900029,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK LARGE 73-1072620EA",7900026,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK MEDIUM 1061728",7900017,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK MEDIUM 1072622",7900025,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",115,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",115,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.98,115,
"BIPAP CAP MASK MEDIUM 1072628",7900022,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK MEDIUM 73-1072619EA",7900024,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK MEDIUM EE NEBULIZER ELBOW",7900033,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK MEDIUM ELBOW LEAK 1",7900032,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK SMALL 1019478",7900027,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK SMALL 1061727",7900019,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CAP MASK SMALL 1072627",7900021,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",140,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.1,140,
"BIPAP CIRCUIT 441-5805000",7915016,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",40,25,,,,,0,"percent of total billed charges","25% of total billed charges",40,25,,,,,0,"percent of total billed charges","25% of total billed charges",40,25,,,,,0,"percent of total billed charges","25% of total billed charges",40,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",40,102,,,,,0,"fee schedule","102% of CMS fee schedule",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",40,100,,,,,0,"fee schedule","100% of CMS fee schedule",40,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",40,100,,,,,0,"fee schedule","100% of CMS fee schedule",40,100,,,,,0,"fee schedule","100% of CMS fee schedule",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",40,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.6,40,
"BIPAP CIRCUIT 73-1069210",7915014,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BIPAP CIRCUIT 73-312107EA",7915011,CDM,272,RC,,,OUTPATIENT,,,26,20.8,,22.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.08,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.3,23.4,
"BIPAP CIRCUIT 73-582073",7915015,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BIPAP CIRCUIT PHILLIPS NIV 73-1069210",7915018,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BIPAP CIRCUIT SMOOTH BORE",7915009,CDM,272,RC,,,OUTPATIENT,,,26,20.8,,22.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.69,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.08,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.3,23.4,
"BIPAP FACE MASK LARGE 1010871",7900016,CDM,272,RC,K0053,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",120,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.8,120,
"BIPAP FACE MASK MEDIUM 1004849",7900015,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",120,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.8,120,
"BIPAP FACE MASK MEDIUM 73-1004849",7900020,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",120,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.8,120,
"BIPAP FACE MASK SMALL 1004878",7915010,CDM,272,RC,A7027,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,130,,,,,0,"fee schedule","130% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",115,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",115,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.98,115,
"BIRTH EMERGENCY NEWBORN PACK",7905801,CDM,272,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"BLADE DERMATOME 75MM",1570372,CDM,272,RC,Q4107,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"BLADE ELECTRODE 165MM",1570829,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BLADE KOBYGARD 380-0006",1570772,CDM,272,RC,,,OUTPATIENT,,,1060,848,,901,85,,,,,0,"percent of total billed charges","85% of total billed charges",265,25,,,,,0,"percent of total billed charges","25% of total billed charges",265,25,,,,,0,"percent of total billed charges","25% of total billed charges",265,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",215.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",598.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",598.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",598.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",598.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",954,90,,,,,0,"percent of total billed charges","90% of total billed charges",371,35,,,,,0,"percent of total billed charges","35% of total billed charges",728.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",954,90,,,,,0,"percent of total billed charges","90% of total billed charges",614.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",215.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",901,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",215.92,954,
"BLADE KOBYGARD 380-0010",1570771,CDM,272,RC,,,OUTPATIENT,,,1570,1256,,1334.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",392.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",392.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",392.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",319.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",887.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",887.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",887.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",887.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1413,90,,,,,0,"percent of total billed charges","90% of total billed charges",549.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1078.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1413,90,,,,,0,"percent of total billed charges","90% of total billed charges",910.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",319.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1334.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",319.81,1413,
"BLADE TORPEDO SHAVER 4.0MM X 13CM",1570817,CDM,272,RC,,,OUTPATIENT,,,495,396,,420.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",123.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",123.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",123.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",100.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",279.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",445.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",173.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",340.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",445.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",287.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",100.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",420.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",100.83,445.5,
"BLOOD COLLECTION ADAPTER",7950347,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BLOOD COLLECTION ADAPTER CARDINAL",7950339,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BLOOD COLLECTION SET W LL BUTTERFLY 21 G",7950379,CDM,272,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"BLOOD COLLECTION SET W LL BUTTERFLY 23 G",7950378,CDM,272,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"BLOOD COLLECTIONS WITH LUER BUTTERFLY",7950362,CDM,272,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"BONE CUTTER ARTHROSCOPY 4.0MM X 13CM",1570818,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"BONE CUTTER ARTHROSCOPY 5.5MM X 13CM",1570828,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"BULB CLOSED WOUND DRAIN",1570901,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"BULB EVACUATOR STERILE S VAC",1570872,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"BURR OVAL 8 FLUTE 4.0MM X 13CM",1570821,CDM,272,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"BURR OVAL FLUSHCUT 8 FLUTE 5.5MM X 13CM",1570823,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"CANNULA ADULT",7919101,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA ADULT 1325 CAREFUSION",7919107,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA ADULT HUD1103",7919120,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA ADULT SOFT PLUS KINK RESITANT",7919144,CDM,272,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"CANNULA ADVANCED ADULT NASAL MVAN",7919127,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CANNULA CONTOUR ERCP 5-4-3",1750029,CDM,272,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"CANNULA ERCP RX",1750028,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"CANNULA INFANT 1828 HUDSON",7901828,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA INFANT BC2745-20",7901829,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CANNULA INFANT CUSHION 7 FT",7901831,CDM,272,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"CANNULA MICROFILTER CO2 MEDLINE",7919145,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CANNULA MICROFILTER CO2 SAMPLING O2 DELI",7919133,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CANNULA MICROFILTER PEDS CO2 MEDLINE",7919142,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CANNULA MICROSTREAM ADVANCED MVAI",7919126,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CANNULA PED 1838 HUDSON",7901838,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA PED 331 E HOSPITAK",7900331,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA PED BC3780-20",7901830,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CANNULA PED SOFT PLUS",7901839,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANNULA PRO SOFT ADULT",7919124,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CANNULA PRO SOFT PED-AS",7919130,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"CANNULA TWIST IN",1570854,CDM,272,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"CANNULA TWIST IN NOTCHED",1570855,CDM,272,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"CAPSULAR TENSION RING",7905137,CDM,272,RC,,,OUTPATIENT,,,1160,928,,986,85,,,,,0,"percent of total billed charges","85% of total billed charges",290,25,,,,,0,"percent of total billed charges","25% of total billed charges",290,25,,,,,0,"percent of total billed charges","25% of total billed charges",290,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1044,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,35,,,,,0,"percent of total billed charges","35% of total billed charges",796.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1044,90,,,,,0,"percent of total billed charges","90% of total billed charges",672.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",986,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",236.29,1044,
"CAPSULE BRAVO 5 PH W/DELIVERY SYSTEM",1750022,CDM,272,RC,,,OUTPATIENT,,,1425,1140,,1211.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",356.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",356.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",356.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",290.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",805.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",805.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",805.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",805.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1282.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",498.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",978.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1282.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",826.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",290.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1211.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",290.27,1282.5,
"CATH BARRX 90 RFA FOCAL",1750021,CDM,272,RC,,,OUTPATIENT,,,7250,5800,,6162.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1476.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6525,90,,,,,0,"percent of total billed charges","90% of total billed charges",2537.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4980.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6525,90,,,,,0,"percent of total billed charges","90% of total billed charges",4205,58,,,,,0,"percent of total billed charges","58% of total billed charges",1476.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6162.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1476.83,6525,
"CATH BARRX CHANNEL RFA ENDOSCOPIC",1750046,CDM,272,RC,,,OUTPATIENT,,,7615,6092,,6472.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1903.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1903.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1903.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1551.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6853.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2665.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",5231.51,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6853.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4416.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1551.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6472.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1551.18,6853.5,
"CATH BARRX RFA EXPRESS BALLOON",1750045,CDM,272,RC,,,OUTPATIENT,,,10285,8228,,8742.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2095.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",9256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3599.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7065.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5965.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2095.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8742.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,9256.5,
"CATH BARRX ULTRA LONG RFA FOCAL",1750044,CDM,272,RC,,,OUTPATIENT,,,8185,6548,,6957.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2046.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2046.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2046.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1667.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",7366.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2864.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",5623.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7366.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4747.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1667.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6957.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1667.28,7366.5,
"CATH CRE BALLOON 5834",1750068,CDM,272,RC,,,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"CATH CRE BALLOON 5837",1750004,CDM,272,RC,,,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"CATH CRE BALLOON 5838",1750003,CDM,272,RC,,,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"CATH CRE BALLOON M00558360",1750012,CDM,272,RC,,,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"CATH CRE BALLOON M00558380",1750071,CDM,272,RC,,,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"CATH ERCP ERCP-1-BT",7905790,CDM,272,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
"CATH FOGARTY ARTERIAL EMBOLECTOMY 3 FR",7905924,CDM,272,RC,,,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,607.5,
"CATH FOGARTY ARTERIAL EMBOLECTOMY 4 FR",7905925,CDM,272,RC,,,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,603,
"CATH HERCULES THREE STAGE G51798",1750077,CDM,272,RC,,,OUTPATIENT,,,990,792,,841.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",247.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",247.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",247.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",201.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",559.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",559.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",559.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",559.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",891,90,,,,,0,"percent of total billed charges","90% of total billed charges",346.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",680.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",891,90,,,,,0,"percent of total billed charges","90% of total billed charges",574.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",201.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",841.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",201.66,891,
"CATH KUMAR CHOLANGIOGRAPHY CC-019",7950257,CDM,272,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"CATH MAXFORCE TTS BALLOON 8918",1750069,CDM,272,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"CATH THORACIC 24FR 570531",7950012,CDM,272,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"CATH THORACIC 24FR 8024",7950046,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH THORACIC 24FR TROCAR 561050",7950027,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"CATH THORACIC 28FR TROCAR 561068",7950045,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CATH THORACIC 32FR 570556",7950011,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH THORACIC 32FR 8032",7950015,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH THORACIC 32FR TROCAR 561076",7950041,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CATH THORACIC 36FR 570564",7950042,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CATH THORACIC 36FR 8036",7950016,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CATH TRAY 16 FR. 300416A",7905291,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CHOLECYSTECTOMY TRAY FNC43XL",7950151,CDM,272,RC,,,OUTPATIENT,,,1960,1568,,1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",686,35,,,,,0,"percent of total billed charges","35% of total billed charges",1346.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",1136.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,1764,
"CHOLECYSTECTOMY TRAY LCB52S",7950148,CDM,272,RC,,,OUTPATIENT,,,1960,1568,,1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1107.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",686,35,,,,,0,"percent of total billed charges","35% of total billed charges",1346.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",1136.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,1764,
"CHOLECYSTECTOMY TRAY TNC61XL",7950147,CDM,272,RC,,,OUTPATIENT,,,2845,2276,,2418.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",711.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",711.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",711.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",579.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1607.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1607.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1607.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1607.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2560.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",995.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1954.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2560.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1650.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",579.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2418.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",579.53,2560.5,
"CIRCUIT HIGH VEL THERAPY AEROSOL DISPO",7919125,CDM,272,RC,,,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",196.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",274.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",159.9,706.5,
"CLAMP UMBILICAL CORD",7950394,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CLAMP UMBILICAL CORD MEDLINE",7950400,CDM,272,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"CRICOTHYROTOMY KIT 2.0MM",7905600,CDM,272,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,792,
"CRICOTHYROTOMY KIT 4.0MM",7905601,CDM,272,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,792,
"CYSTO/BLADDER IRRIGATION SET",2610531,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CYTOLOGY BRUSH RX",1750023,CDM,272,RC,,,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,418.5,
"DISSECTING ELECTRODE STORZ",1570906,CDM,272,RC,,,OUTPATIENT,,,1450,1160,,1232.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",362.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",362.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",295.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",819.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1305,90,,,,,0,"percent of total billed charges","90% of total billed charges",507.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",996.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1305,90,,,,,0,"percent of total billed charges","90% of total billed charges",841,58,,,,,0,"percent of total billed charges","58% of total billed charges",295.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1232.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",295.37,1305,
"DISSECTOR CURVED 4.0MM X 13CM",1570819,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"DRAIN 10FR CHANNEL ROUND HUBLESS 072227",1570793,CDM,272,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"DRAIN 15FR CHANNEL ROUND HUBLESS 072229",1570802,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"DREAMTOME RX 44 260CM",1750026,CDM,272,RC,,,OUTPATIENT,,,1750,1400,,1487.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",356.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1575,90,,,,,0,"percent of total billed charges","90% of total billed charges",612.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1202.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1575,90,,,,,0,"percent of total billed charges","90% of total billed charges",1015,58,,,,,0,"percent of total billed charges","58% of total billed charges",356.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1487.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",356.48,1575,
"DREAMTOME RX 44 450CM",1750059,CDM,272,RC,,,OUTPATIENT,,,1750,1400,,1487.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",356.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",988.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1575,90,,,,,0,"percent of total billed charges","90% of total billed charges",612.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1202.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1575,90,,,,,0,"percent of total billed charges","90% of total billed charges",1015,58,,,,,0,"percent of total billed charges","58% of total billed charges",356.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1487.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",356.48,1575,
"DREAMWIRE ANGLED .035 260CM",1750031,CDM,272,RC,,,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,670.5,
"DREAMWIRE ST STIFF .035 260CM",1750030,CDM,272,RC,,,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,670.5,
"DREAMWIRE ST STIFF .035 450CM",1750032,CDM,272,RC,,,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,670.5,
"DRESSING KENDALL FOAM 6 X 6",7950276,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DRESSING KENDALL FOAM ISLAND 6 X 6",7950277,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DRESSING NASAL 4.5 CM",7905954,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"DRESSING NASAL 8 CM",7905955,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"DRESSING OPTIFOAM 3 X 3",7950279,CDM,272,RC,A6209,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING OPTIFOAM 4 X 5",7950278,CDM,272,RC,A6210,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DRESSING OPTIFOAM GENTLE EX SACRUM",7950309,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"DRESSING OPTIFOAM NON ADHESIVE 6 X 6",7950294,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DRESSING SURGICAL AQUACEL AG 3.5 X 10",1570803,CDM,272,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"DRESSING SURGICAL AQUACEL AG 3.5 X 12",1570804,CDM,272,RC,,,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"DRESSING WOUND OPTICELL AG+ SILVER",7950316,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"DRILL BIT",7901119,CDM,272,RC,,,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",250,25,,,,,0,"percent of total billed charges","25% of total billed charges",250,25,,,,,0,"percent of total billed charges","25% of total billed charges",250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",203.7,900,
"DRILL BIT CANNULATED 2.6",1570868,CDM,272,RC,,,OUTPATIENT,,,787.5,630,,669.38,85,,,,,0,"percent of total billed charges","85% of total billed charges",196.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",160.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",708.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.63,35,,,,,0,"percent of total billed charges","35% of total billed charges",541.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",708.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",456.75,58,,,,,0,"percent of total billed charges","58% of total billed charges",160.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",669.38,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",160.41,708.75,
"ELECTRODE BALL 0015",7950333,CDM,272,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"ELECTRODE BLADE INSULATED E1455",7950022,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ELECTRODE FLAT BLADE 4  139112",7950021,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ELECTRODE FLAT BLADE 6  138107",7950044,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELECTRODE LAPAROSCOPIC 0018",7950296,CDM,272,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"ELECTRODE LAPAROSCOPIC 0020",7950246,CDM,272,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"ENDO CLIP APPLIER ER320",7950143,CDM,272,RC,,,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"ENDO COMPLIANCE KIT",7950322,CDM,272,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"ENDO COMPLIANCE KIT",7950332,CDM,272,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"ENDO POUCH RETRIEVER (POUCH)",7950144,CDM,272,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"ENDO TRACH TUBE",7919401,CDM,272,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"ENDOPATH BABCOCK GRASPERS 5BB",7950152,CDM,272,RC,,,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"ENDOPATH BLUNT TIP DISSECTOR BTD05",7950171,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"ENDOPATH DISSECTOR 5DCD",7950145,CDM,272,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"ENDOPATH GRASPERS 5DSG",7950142,CDM,272,RC,,,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",43.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",35.65,157.5,
"ENDOPATH SCISSORS 5DCS",7950150,CDM,272,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
"ENDOPATH STABILITY SLEEVE CB5LT",7950185,CDM,272,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"EVACUATED CONTAINER /PARACENTIS",4600100,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"EXCALIBUR 4.0MM X 13CM",1570820,CDM,272,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"EXCALIBUR 5.5MM X 13CM",1570822,CDM,272,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"EXTRACTOR PRO RX RETRIEVAL BALLOON 12-15",1750042,CDM,272,RC,,,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,589.5,
"EXTRACTOR PRO RX RETRIEVAL BALLOON 15-18",1750043,CDM,272,RC,,,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,589.5,
"EXTRACTOR PRO RX RETRIEVAL BALLOON 9-12",1750041,CDM,272,RC,,,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,589.5,
"FIBER TAPE 2MM 30  BLUE BRAIDED POLYBLEN",1570657,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"FIBERSTITCH IMPLANT CURVED",1570860,CDM,272,RC,,,OUTPATIENT,,,2600,2080,,2210,85,,,,,0,"percent of total billed charges","85% of total billed charges",650,25,,,,,0,"percent of total billed charges","25% of total billed charges",650,25,,,,,0,"percent of total billed charges","25% of total billed charges",650,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",529.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2340,90,,,,,0,"percent of total billed charges","90% of total billed charges",910,35,,,,,0,"percent of total billed charges","35% of total billed charges",1786.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2340,90,,,,,0,"percent of total billed charges","90% of total billed charges",1508,58,,,,,0,"percent of total billed charges","58% of total billed charges",529.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2210,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",529.62,2340,
"FIBERSTITCH IMPLANT CURVED 24 DEGREE",1570861,CDM,272,RC,,,OUTPATIENT,,,2600,2080,,2210,85,,,,,0,"percent of total billed charges","85% of total billed charges",650,25,,,,,0,"percent of total billed charges","25% of total billed charges",650,25,,,,,0,"percent of total billed charges","25% of total billed charges",650,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",529.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1469,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2340,90,,,,,0,"percent of total billed charges","90% of total billed charges",910,35,,,,,0,"percent of total billed charges","35% of total billed charges",1786.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2340,90,,,,,0,"percent of total billed charges","90% of total billed charges",1508,58,,,,,0,"percent of total billed charges","58% of total billed charges",529.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2210,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",529.62,2340,
"FILTER SMOKE LAPROSHIELD LSF1",1570796,CDM,272,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"FISTULA PLUG BIODESIGN G53614",1570799,CDM,272,RC,C1763,HCPCS,OUTPATIENT,,,4765,3812,,4050.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",970.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4288.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1667.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3273.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4288.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2763.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",970.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4050.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",970.63,4288.5,
"FISTULA PLUG BIODESIGN G54613",1570798,CDM,272,RC,C1763,HCPCS,OUTPATIENT,,,4510,3608,,3833.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1127.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1127.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1127.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",918.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4059,90,,,,,0,"percent of total billed charges","90% of total billed charges",1578.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3098.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4059,90,,,,,0,"percent of total billed charges","90% of total billed charges",2615.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",918.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3833.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",918.69,4059,
"FIXATION DEVICE ABSORBATACK 5MM",7950348,CDM,272,RC,,,OUTPATIENT,,,10237.5,8190,,8701.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",2559.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",2559.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",2559.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2085.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",9213.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",3583.13,35,,,,,0,"percent of total billed charges","35% of total billed charges",7033.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9213.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",5937.75,58,,,,,0,"percent of total billed charges","58% of total billed charges",2085.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8701.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,9213.75,
"FIXATION DEVICE MAXTACK30",7950401,CDM,272,RC,,,OUTPATIENT,,,2265,1812,,1925.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",566.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",566.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",566.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",461.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2038.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",792.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1556.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2038.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1313.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",461.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1925.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",461.38,2038.5,
"FIXATION DEVICE PROTACK 5MM",7950125,CDM,272,RC,,,OUTPATIENT,,,1985,1588,,1687.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",404.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1786.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",694.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1363.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1786.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1151.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",404.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1687.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",404.34,1786.5,
"FIXATION DEVICE RELIATACK W/30 STANDARD",7950349,CDM,272,RC,,,OUTPATIENT,,,2265,1812,,1925.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",566.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",566.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",566.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",461.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2038.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",792.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1556.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2038.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1313.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",461.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1925.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",461.38,2038.5,
"FIXATION DEVICE SECURESTRAP",7950153,CDM,272,RC,,,OUTPATIENT,,,2360,1888,,2006,85,,,,,0,"percent of total billed charges","85% of total billed charges",590,25,,,,,0,"percent of total billed charges","25% of total billed charges",590,25,,,,,0,"percent of total billed charges","25% of total billed charges",590,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",480.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1333.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1333.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1333.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1333.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2124,90,,,,,0,"percent of total billed charges","90% of total billed charges",826,35,,,,,0,"percent of total billed charges","35% of total billed charges",1621.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2124,90,,,,,0,"percent of total billed charges","90% of total billed charges",1368.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",480.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2006,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",480.73,2124,
"FIXATION DEVICE SORBAFIX 0113116",7950154,CDM,272,RC,,,OUTPATIENT,,,2830,2264,,2405.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",576.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2547,90,,,,,0,"percent of total billed charges","90% of total billed charges",990.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1944.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2547,90,,,,,0,"percent of total billed charges","90% of total billed charges",1641.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",576.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2405.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",576.47,2547,
"FIXATION SYSTEM OPTIFIX AT 0113330",7950160,CDM,272,RC,,,OUTPATIENT,,,2830,2264,,2405.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",576.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2547,90,,,,,0,"percent of total billed charges","90% of total billed charges",990.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1944.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2547,90,,,,,0,"percent of total billed charges","90% of total billed charges",1641.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",576.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2405.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",576.47,2547,
"FIXATION SYSTEM OPTIFIX OPEN 0113320",7950128,CDM,272,RC,,,OUTPATIENT,,,2830,2264,,2405.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",707.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",576.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1598.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2547,90,,,,,0,"percent of total billed charges","90% of total billed charges",990.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1944.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2547,90,,,,,0,"percent of total billed charges","90% of total billed charges",1641.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",576.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2405.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",576.47,2547,
"FORCEP BIOPSY DISP. FB220K.A",7905048,CDM,272,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"FORCEP BIOPSY DISP. FB220U.A",7905049,CDM,272,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"FORCEP BIOPSY DISP. FB240U.A",7905046,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"FORCEP BIOPSY MULTIBITE 1012",7905045,CDM,272,RC,,,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"FORCEP BIOPSY RADIAL JAW 4",7905050,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"FORCEP BIPOLAR CUTTING",7950112,CDM,272,RC,,,OUTPATIENT,,,1690,1352,,1436.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",344.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",954.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",954.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",954.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",954.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1521,90,,,,,0,"percent of total billed charges","90% of total billed charges",591.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1161.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1521,90,,,,,0,"percent of total billed charges","90% of total billed charges",980.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",344.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1436.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",344.25,1521,
"FORCEP GRASPING POLYGRAB",7905044,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"FORCEP HOT BIOPSY",7950070,CDM,272,RC,,,OUTPATIENT,,,1390,1112,,1181.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",347.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",347.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",347.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",283.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",785.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",785.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",785.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",785.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1251,90,,,,,0,"percent of total billed charges","90% of total billed charges",486.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",954.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1251,90,,,,,0,"percent of total billed charges","90% of total billed charges",806.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",283.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1181.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",283.14,1251,
"FORCEP HOT BIOPSY DISP. FD210U",7905047,CDM,272,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"FORCEP RESCUE COMBO RAT TOOTH/ALLIGATOR",7905052,CDM,272,RC,,,OUTPATIENT,,,383,306.4,,325.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",95.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",95.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",95.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",216.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",344.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.05,35,,,,,0,"percent of total billed charges","35% of total billed charges",263.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",344.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.14,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",325.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.02,344.7,
"FORCEPS BABCOCK GRASPING DISPO",1570801,CDM,272,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"FORCEPS HET BIPOLAR",1750060,CDM,272,RC,,,OUTPATIENT,,,2190,1752,,1861.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",547.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",547.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",547.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",446.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1237.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1237.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1237.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1237.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1971,90,,,,,0,"percent of total billed charges","90% of total billed charges",766.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1504.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1971,90,,,,,0,"percent of total billed charges","90% of total billed charges",1270.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",446.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1861.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",446.1,1971,
"FORCEPS SPYBITE BIOPSY",1750055,CDM,272,RC,,,OUTPATIENT,,,2285,1828,,1942.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",465.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1291.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1291.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1291.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1291.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2056.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",799.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1569.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2056.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1325.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",465.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1942.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",465.45,2056.5,
"GAS SAMPLING LINE 10 FOOT MALE/MALE",7919129,CDM,272,RC,,,OUTPATIENT,,,28,22.4,,23.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",7,25,,,,,0,"percent of total billed charges","25% of total billed charges",7,25,,,,,0,"percent of total billed charges","25% of total billed charges",7,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",15.82,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",15.82,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",15.82,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",15.82,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.8,35,,,,,0,"percent of total billed charges","35% of total billed charges",19.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.24,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",23.8,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.7,25.2,
"GAUZE BORDER ADHESIVE 4X10 W/ 2X8 PAD",7950361,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE BORDER ADHESIVE 4X14  ISLAND WOUND",7950393,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 1  IODOFORM NON256015",7905512,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 1  PLAIN NON265015",7905503,CDM,272,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"GAUZE PACKING 1/2  IODOFORM NON256125",7905513,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 1/2  PLAIN NON255125",7905517,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 1/4  IODOFORM NON256145",7905509,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 1/4  PLAIN NON255145",7905514,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 2  IODOFORM NON256025",7905515,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GAUZE PACKING 2  PLAIN NON255025",7905518,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GELFOAM 3/4 X 2-3/8",7905532,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"GELPORT LAPAROSCOPIC SYSTEM C8XX2",1570080,CDM,272,RC,,,OUTPATIENT,,,3185,2548,,2707.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",796.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",796.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",796.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",648.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1799.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1799.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1799.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1799.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2866.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1114.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2188.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2866.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1847.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",648.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2707.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",648.78,2866.5,
"GOLD PROBE 6007",1750002,CDM,272,RC,,,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,594,
"GOLD PROBE 6015",1750014,CDM,272,RC,,,OUTPATIENT,,,1380,1104,,1173,85,,,,,0,"percent of total billed charges","85% of total billed charges",345,25,,,,,0,"percent of total billed charges","25% of total billed charges",345,25,,,,,0,"percent of total billed charges","25% of total billed charges",345,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",281.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1242,90,,,,,0,"percent of total billed charges","90% of total billed charges",483,35,,,,,0,"percent of total billed charges","35% of total billed charges",948.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1242,90,,,,,0,"percent of total billed charges","90% of total billed charges",800.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",281.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1173,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",281.11,1242,
"HAND TRAY BASIC SOPRLBHTAG",7901201,CDM,272,RC,,,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,301.5,
"HOOK/TRIANGLE BLADE PACK 3056",1570370,CDM,272,RC,,,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,684,
"INSTRUMENT CANNULA 7MMX 7CM",1570866,CDM,272,RC,,,OUTPATIENT,,,132,105.6,,112.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",33,25,,,,,0,"percent of total billed charges","25% of total billed charges",33,25,,,,,0,"percent of total billed charges","25% of total billed charges",33,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",118.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",90.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",118.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",112.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.89,118.8,
"INTERPULSE PULSED LAVAGE SYSTEM",1570846,CDM,272,RC,,,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"IRRIGATION SET BRAUN V4639",2610506,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"IRRIGATION TUBING SET SPYGLASS",1750056,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"IV ANGIOCATH 14 GA X 3.25",2613078,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"IV ANGIOCATH 14 GA X 5.25",2613088,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"IV ANGIOCATH 20 GAX 1.88 IN",2613091,CDM,272,RC,,,OUTPATIENT,,,21,16.8,,17.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.87,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.87,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.87,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.87,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.35,35,,,,,0,"percent of total billed charges","35% of total billed charges",14.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.18,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.28,18.9,
"IV ANGIOCATH 24 GAX 1.88 IN",2613092,CDM,272,RC,,,OUTPATIENT,,,22,17.6,,18.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",12.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",12.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",12.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",12.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.7,35,,,,,0,"percent of total billed charges","35% of total billed charges",15.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.48,19.8,
"IV CATH INTROCAN SAFETY 20 X 1 425454602",2613082,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH. 14 X 1.25 4251890-02",2613086,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IV CATH. 16 X 1.25 4252586-02",2613087,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"J VAC  RESERVOIR 150 ML",7905732,CDM,272,RC,,,OUTPATIENT,,,132,105.6,,112.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",33,25,,,,,0,"percent of total billed charges","25% of total billed charges",33,25,,,,,0,"percent of total billed charges","25% of total billed charges",33,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",74.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",118.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",90.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",118.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",112.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.89,118.8,
"J VAC  RESERVOIR BULB",7905738,CDM,272,RC,,,OUTPATIENT,,,110,88,,93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",62.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",75.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,99,
"JAGTOME RX 39 260CM",1750027,CDM,272,RC,,,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"JAGTOME RX 39 450CM",1750058,CDM,272,RC,,,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"JAGWIRE ST .025 450CM",1750033,CDM,272,RC,,,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,427.5,
"K WIRE ARTHREX",1570869,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"KNOT PUSHER/ SUTURE CUTTER",1570863,CDM,272,RC,,,OUTPATIENT,,,1157,925.6,,983.45,85,,,,,0,"percent of total billed charges","85% of total billed charges",289.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",289.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",289.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",235.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",653.71,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",653.71,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",653.71,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",653.71,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",404.95,35,,,,,0,"percent of total billed charges","35% of total billed charges",794.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",671.06,58,,,,,0,"percent of total billed charges","58% of total billed charges",235.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",983.45,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",235.68,1041.3,
"LARYNGOSCOPE GLIDESCOPE BLADE 4 AVL",1570835,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"LARYNGOSCOPE HANDLE/BLADE BRITEPRO 3.5",1570847,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LARYNGOSCOPE HANDLE/BLADE BRITEPRO SOLO",1570845,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LARYNGOSCOPE HANDLE/BLADE MAC 3",1570858,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LARYNGOSCOPE HANDLE/BLADE MAC 4",1570859,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LARYNGOSCOPE HANDLE/BLADE MILLER 2",1570862,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LARYNGOSCOPE VIDEO LOPRO S1",1570874,CDM,272,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"LARYNGOSCOPE VIDEO LOPRO S2",1570875,CDM,272,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"LARYNGOSCOPE VIDEO LOPRO S3",1570848,CDM,272,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"LARYNGOSCOPE VIDEO LOPRO S4",1570849,CDM,272,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"LIGACLIP CLIP APPLIER MCM30",7950139,CDM,272,RC,,,OUTPATIENT,,,260,208,,221,85,,,,,0,"percent of total billed charges","85% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",91,35,,,,,0,"percent of total billed charges","35% of total billed charges",178.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",221,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,234,
"LIGACLIP CLIP APPLIER MCS20",7950138,CDM,272,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"LIGATION CLIP POLY NON ABSORB 544240",7950110,CDM,272,RC,,,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"LIGATION CLIP POLYMER NON ABSORBABLE",7950113,CDM,272,RC,,,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"LIGATOR SAEED MULTI-BAND SIX SHOOTER",1750013,CDM,272,RC,,,OUTPATIENT,,,1025,820,,871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",358.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",704.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",594.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",208.79,922.5,
"LINEAR CUTTER ECHELON LONG60A",7950291,CDM,272,RC,,,OUTPATIENT,,,1315,1052,,1117.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",328.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",328.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",328.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",267.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1183.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",460.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",903.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1183.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",762.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",267.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1117.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",267.87,1183.5,
"LINEAR CUTTER POWERED ECHELON PLEE60A",7950284,CDM,272,RC,,,OUTPATIENT,,,1640,1312,,1394,85,,,,,0,"percent of total billed charges","85% of total billed charges",410,25,,,,,0,"percent of total billed charges","25% of total billed charges",410,25,,,,,0,"percent of total billed charges","25% of total billed charges",410,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",334.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",926.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",926.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",926.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",926.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1476,90,,,,,0,"percent of total billed charges","90% of total billed charges",574,35,,,,,0,"percent of total billed charges","35% of total billed charges",1126.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1476,90,,,,,0,"percent of total billed charges","90% of total billed charges",951.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",334.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1394,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",334.07,1476,
"LINEAR CUTTER PROXIMATE 55MM TLC55",7950225,CDM,272,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"LINEAR CUTTER PROXIMATE 75MM TCT75",7950303,CDM,272,RC,,,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"LINEAR CUTTER PROXIMATE 75MM TLC75",7950237,CDM,272,RC,,,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",199.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,513,
"LINEAR CUTTER RELOAD ECHEL WHITE GST60W",7950287,CDM,272,RC,,,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"LINEAR CUTTER RELOAD ECHELON BLUE GCR40B",7950366,CDM,272,RC,,,OUTPATIENT,,,1300,1040,,1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",455,35,,,,,0,"percent of total billed charges","35% of total billed charges",893.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",754,58,,,,,0,"percent of total billed charges","58% of total billed charges",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",264.81,1170,
"LINEAR CUTTER RELOAD ECHELON BLUE GCS40B",7950364,CDM,272,RC,,,OUTPATIENT,,,1300,1040,,1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",455,35,,,,,0,"percent of total billed charges","35% of total billed charges",893.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",754,58,,,,,0,"percent of total billed charges","58% of total billed charges",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",264.81,1170,
"LINEAR CUTTER RELOAD ECHELON BLUE GST60B",7950285,CDM,272,RC,,,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,607.5,
"LINEAR CUTTER RELOAD ECHELON GRN GST60G",7950286,CDM,272,RC,,,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,607.5,
"LINEAR CUTTER RELOAD TCR55",7950226,CDM,272,RC,,,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"LINEAR CUTTER RELOAD TCR75",7950249,CDM,272,RC,,,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,274.5,
"LINEAR CUTTER RELOAD THICK 75MM TRT75",7950254,CDM,272,RC,,,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"LINEAR STAPLER RELOAD XR60B",7950242,CDM,272,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"LINEAR STAPLER RELOAD XR60G",7950258,CDM,272,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"LINEAR STAPLER RELOADABLE TX60B",7950170,CDM,272,RC,,,OUTPATIENT,,,370,296,,314.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",75.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",333,90,,,,,0,"percent of total billed charges","90% of total billed charges",129.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",254.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",333,90,,,,,0,"percent of total billed charges","90% of total billed charges",214.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",75.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",314.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",75.37,333,
"LINEAR STAPLER RELOADABLE TX60G",7950161,CDM,272,RC,,,OUTPATIENT,,,370,296,,314.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",92.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",75.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",209.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",333,90,,,,,0,"percent of total billed charges","90% of total billed charges",129.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",254.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",333,90,,,,,0,"percent of total billed charges","90% of total billed charges",214.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",75.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",314.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",75.37,333,
"LOCKING DEVICE AND BIOPSY CAP SYSTEM",1750025,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"LOOP VESSEL RED MAXI SILICONE",1570650,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LOOP VESSEL RED MINI SILICONE",1570651,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LUERLOK ACCESS DEVICE",7950359,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MAG TRACE BREAST TRACING MARKER",7950398,CDM,272,RC,,,OUTPATIENT,,,5000,4000,,4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",1750,35,,,,,0,"percent of total billed charges","35% of total billed charges",3435,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",2900,58,,,,,0,"percent of total billed charges","58% of total billed charges",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1018.5,4500,
"MANIFOLD NEPTUNE FOUR PORT",1570827,CDM,272,RC,,,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"MARKER BREAST BIOPSY HYDROMARK T1",7950299,CDM,272,RC,,,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,427.5,
"MARKER BREAST BIOPSY HYDROMARK T3",7950310,CDM,272,RC,,,OUTPATIENT,,,355,284,,301.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",88.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",88.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",88.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",72.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",319.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",124.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",243.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",319.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",205.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",72.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",301.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",72.31,319.5,
"MARKER BREAST BIOPSY HYDROMARK T4",7950300,CDM,272,RC,,,OUTPATIENT,,,355,284,,301.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",88.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",88.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",88.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",72.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",200.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",319.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",124.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",243.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",319.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",205.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",72.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",301.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",72.31,319.5,
"MARKER BREAST BIOPSY MAMMOSTAR 14G",7950301,CDM,272,RC,,,OUTPATIENT,,,460,368,,391,85,,,,,0,"percent of total billed charges","85% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",115,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",161,35,,,,,0,"percent of total billed charges","35% of total billed charges",316.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",266.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",391,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",93.7,414,
"MARKER BREAST BIOPSY TUMARK CONIC 12 CM",7950352,CDM,272,RC,,,OUTPATIENT,,,400,320,,340,85,,,,,0,"percent of total billed charges","85% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",140,35,,,,,0,"percent of total billed charges","35% of total billed charges",274.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",232,58,,,,,0,"percent of total billed charges","58% of total billed charges",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",340,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",81.48,360,
"MARKER BREAST BIOPSY TUMARK VISION 12 CM",7950351,CDM,272,RC,,,OUTPATIENT,,,400,320,,340,85,,,,,0,"percent of total billed charges","85% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",140,35,,,,,0,"percent of total billed charges","35% of total billed charges",274.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",232,58,,,,,0,"percent of total billed charges","58% of total billed charges",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",340,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",81.48,360,
"MARKER BREAST TISSUE SENOMARK ULTRACOR",7950223,CDM,272,RC,,,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,274.5,
"MARKER BREAST TISSUE ULTRACLIP 862017D",7950244,CDM,272,RC,,,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"MESHBOARD 1.5:1 SKIN GRAFT CARRIER",1570371,CDM,272,RC,Q4107,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"MORGAN LENS",7905135,CDM,272,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"NASAL ATOMIZER 3ML LL",7905960,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"NASAL EPISTAXIS SMALL 5.5CMX1.5CMX2.5CM",7905983,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"NASAL RAPID RHINO 5.5 CM",7905956,CDM,272,RC,,,OUTPATIENT,,,195,156,,165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",48.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",110.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",68.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",133.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",39.72,175.5,
"NASAL RAPID RHINO 7.5 CM",7905957,CDM,272,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"NASAL RHINO ROCKET SLIMLINE MED",7905959,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"NEEDLE BONE MARROW DIN1515X",7905938,CDM,272,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"NEEDLE ECHOGENIC STIMUPLEX ULTRA 360",7950311,CDM,272,RC,,,OUTPATIENT,,,67,53.6,,56.95,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",37.86,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",37.86,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",37.86,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",37.86,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.45,35,,,,,0,"percent of total billed charges","35% of total billed charges",46.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.86,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",56.95,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.65,60.3,
"NEEDLE EZ-IO W/STABILIZER KIT 9001P",7905945,CDM,272,RC,,,OUTPATIENT,,,535,428,,454.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",108.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",481.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",187.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",367.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",481.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",310.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",108.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",454.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",108.98,481.5,
"NEEDLE EZ-IO W/STABILIZER KIT 9018P",7905947,CDM,272,RC,,,OUTPATIENT,,,535,428,,454.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",108.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",481.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",187.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",367.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",481.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",310.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",108.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",454.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",108.98,481.5,
"NEEDLE EZ-IO W/STABILIZER KIT 9079P",7905946,CDM,272,RC,,,OUTPATIENT,,,535,428,,454.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",133.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",108.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",302.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",481.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",187.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",367.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",481.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",310.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",108.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",454.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",108.98,481.5,
"NEEDLE GRANEE 10165",7950184,CDM,272,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"NEEDLE INTRAOSSEOUS CAREFUSION DIN1518X",7905934,CDM,272,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"NEEDLE INTRAOSSEOUS COOK",7905937,CDM,272,RC,,,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"NEEDLE SCORPION MULTIFIRE",1570816,CDM,272,RC,,,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",170.09,751.5,
"NEONATAL MASK 10 50505 MER MED",7900505,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NOVAGOLD GUIDEWIRE .018 260CM",1750034,CDM,272,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,792,
"NRLON SUTURE 0 8X18IN SUB FOR 1969-62",1570931,CDM,272,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"NU-GAUZE 1  IODOFORM 7833",7905506,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NU-GAUZE 1/2  IODOFORM 7832",7905507,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NU-GAUZE 1/4  IODOFORM 7831",7905508,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NU-GAUZE 2  IODOFORM 8758",7905531,CDM,272,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"ORTHO BASIC HAND TRAY",7901200,CDM,272,RC,,,OUTPATIENT,,,265,212,,225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",66.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",149.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",92.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",182.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",153.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",53.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",225.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",53.98,238.5,
"ORTHOPEDIC W TRAY SOPRLOPTAG",7901203,CDM,272,RC,,,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,427.5,
"PEG KIT ENDOVIVE SAFETY 20FR",7905847,CDM,272,RC,,,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"PEG KIT ENDOVIVE SAFETY 20FR ENFIT",7905841,CDM,272,RC,,,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"PEG KIT ENDOVIVE SAFETY 20FR ENFIT",7905853,CDM,272,RC,,,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"PLEDGET FELT RECTANGLE 3/16 X 1/4",1570789,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PLEDGET FELT RECTANGLE 3/8 X 3/16",1570788,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PROBE COVER 4 X 48 MEDLINE",1570885,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PROBE COVER 6 X 48 ADVANCE MEDICAL",1570907,CDM,272,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PROBE COVER 6 X 48 MEDLINE",1570886,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PROBE COVER GENERAL PURPOSE 4 X 48",1570797,CDM,272,RC,,,OUTPATIENT,,,23,18.4,,19.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.05,35,,,,,0,"percent of total billed charges","35% of total billed charges",15.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.34,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.69,20.7,
"PROBE EHL BILIARY SPYGLASS DS",1750053,CDM,272,RC,,,OUTPATIENT,,,1980,1584,,1683,85,,,,,0,"percent of total billed charges","85% of total billed charges",495,25,,,,,0,"percent of total billed charges","25% of total billed charges",495,25,,,,,0,"percent of total billed charges","25% of total billed charges",495,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",403.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1118.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1118.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1118.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1118.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1782,90,,,,,0,"percent of total billed charges","90% of total billed charges",693,35,,,,,0,"percent of total billed charges","35% of total billed charges",1360.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1782,90,,,,,0,"percent of total billed charges","90% of total billed charges",1148.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",403.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1683,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",403.33,1782,
"PROBE FIAPC STRAIGHT FIRE FLEXIBLE",1750020,CDM,272,RC,,,OUTPATIENT,,,1015,812,,862.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",253.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",253.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",253.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",206.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",573.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",573.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",573.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",573.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",913.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",355.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",697.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",913.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",588.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",206.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",862.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",206.76,913.5,
"PULSAVAC PLUS SHOWER KIT",1570851,CDM,272,RC,,,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"RAPID REFILL CONTINUOUS INJ SYSTEM",1750024,CDM,272,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"RESCUENET DGN-538-5",7905586,CDM,272,RC,,,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"RESOLUTION CLIP 360 M00521230",1750065,CDM,272,RC,,,OUTPATIENT,,,1075,860,,913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",376.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",738.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",623.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",218.98,967.5,
"RESOLUTION CLIP 360 M00521231",1750067,CDM,272,RC,,,OUTPATIENT,,,1075,860,,913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",376.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",738.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",623.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",218.98,967.5,
"RESOLUTION CLIP M00522610",1750015,CDM,272,RC,,,OUTPATIENT,,,865,692,,735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",302.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",594.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",501.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,778.5,
"RESOLUTION CLIP M00522611",1750019,CDM,272,RC,,,OUTPATIENT,,,865,692,,735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",302.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",594.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",501.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,778.5,
"RESOLUTION CLIP M00522612",1750066,CDM,272,RC,,,OUTPATIENT,,,865,692,,735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",302.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",594.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",501.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,778.5,
"RETRACTOR HANDHELD SOFT TISSUE DISPO",1570800,CDM,272,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"SCREW CANCELLOUS 3X12",1570839,CDM,272,RC,,,OUTPATIENT,,,157.5,126,,133.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",39.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",39.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",39.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",32.08,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",88.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.99,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.99,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",141.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.13,35,,,,,0,"percent of total billed charges","35% of total billed charges",108.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",141.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",91.35,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.08,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",133.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",32.08,141.75,
"SCREW CANCELLOUS 3X14",1570838,CDM,272,RC,,,OUTPATIENT,,,157,125.6,,133.45,85,,,,,0,"percent of total billed charges","85% of total billed charges",39.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",39.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",39.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",88.71,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.71,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.71,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",88.71,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",141.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.95,35,,,,,0,"percent of total billed charges","35% of total billed charges",107.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",141.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",91.06,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",133.45,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.98,141.3,
"SCREW CANNULATED 4.0X40",1570871,CDM,272,RC,,,OUTPATIENT,,,787.5,630,,669.38,85,,,,,0,"percent of total billed charges","85% of total billed charges",196.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",196.88,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",160.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",444.94,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",708.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.63,35,,,,,0,"percent of total billed charges","35% of total billed charges",541.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",708.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",456.75,58,,,,,0,"percent of total billed charges","58% of total billed charges",160.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",669.38,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",160.41,708.75,
"SCREW CORTICAL 2.7 X 16 MM",1570879,CDM,272,RC,,,OUTPATIENT,,,630.72,504.58,,536.11,85,,,,,0,"percent of total billed charges","85% of total billed charges",157.68,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.68,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.68,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",356.36,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",356.36,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",356.36,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",356.36,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",567.65,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",433.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",567.65,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.82,58,,,,,0,"percent of total billed charges","58% of total billed charges",128.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",536.11,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.48,567.65,
"SHOULDER STABILIZATION KIT",1570856,CDM,272,RC,,,OUTPATIENT,,,235,188,,199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",47.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",82.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",161.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",47.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",47.87,211.5,
"SINUS BALLOON CATH 6MM SPIN RELIEVA",1570762,CDM,272,RC,,,OUTPATIENT,,,7145,5716,,6073.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1786.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1786.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1786.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1455.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6430.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2500.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4908.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6430.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4144.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1455.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6073.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1455.44,6430.5,
"SINUS BALLOON CATHETER 3.5MM ULTIRRA",1570758,CDM,272,RC,,,OUTPATIENT,,,3980,3184,,3383,85,,,,,0,"percent of total billed charges","85% of total billed charges",995,25,,,,,0,"percent of total billed charges","25% of total billed charges",995,25,,,,,0,"percent of total billed charges","25% of total billed charges",995,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",810.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3582,90,,,,,0,"percent of total billed charges","90% of total billed charges",1393,35,,,,,0,"percent of total billed charges","35% of total billed charges",2734.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3582,90,,,,,0,"percent of total billed charges","90% of total billed charges",2308.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",810.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3383,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",810.73,3582,
"SINUS BALLOON CATHETER 5MM RELIEVA",1570753,CDM,272,RC,,,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,2983.5,
"SINUS BALLOON CATHETER 5MM ULTIRRA",1570760,CDM,272,RC,,,OUTPATIENT,,,3800,3040,,3230,85,,,,,0,"percent of total billed charges","85% of total billed charges",950,25,,,,,0,"percent of total billed charges","25% of total billed charges",950,25,,,,,0,"percent of total billed charges","25% of total billed charges",950,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",774.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3420,90,,,,,0,"percent of total billed charges","90% of total billed charges",1330,35,,,,,0,"percent of total billed charges","35% of total billed charges",2610.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3420,90,,,,,0,"percent of total billed charges","90% of total billed charges",2204,58,,,,,0,"percent of total billed charges","58% of total billed charges",774.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3230,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",774.06,3420,
"SINUS BALLOON CATHETER 7MM RELIEVA",1570754,CDM,272,RC,,,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,2983.5,
"SINUS BALLOON CATHETER 7MM ULTIRRA",1570759,CDM,272,RC,,,OUTPATIENT,,,3800,3040,,3230,85,,,,,0,"percent of total billed charges","85% of total billed charges",950,25,,,,,0,"percent of total billed charges","25% of total billed charges",950,25,,,,,0,"percent of total billed charges","25% of total billed charges",950,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",774.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3420,90,,,,,0,"percent of total billed charges","90% of total billed charges",1330,35,,,,,0,"percent of total billed charges","35% of total billed charges",2610.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3420,90,,,,,0,"percent of total billed charges","90% of total billed charges",2204,58,,,,,0,"percent of total billed charges","58% of total billed charges",774.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3230,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",774.06,3420,
"SINUS BALLOON INFLATION DEVICE BID30",1570757,CDM,272,RC,,,OUTPATIENT,,,375,300,,318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",93.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",131.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",257.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",217.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.39,337.5,
"SINUS BALLOON SYSTEM SINUS GUIDE",1570763,CDM,272,RC,,,OUTPATIENT,,,1365,1092,,1160.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",341.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",341.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",341.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",278.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",771.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",771.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",771.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",771.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1228.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",477.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",937.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1228.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",791.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",278.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1160.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",278.05,1228.5,
"SINUS BLADE SUCTION SHAVER",1570745,CDM,272,RC,,,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,594,
"SINUS GUIDE CATHETER F-70C",1570751,CDM,272,RC,,,OUTPATIENT,,,1795,1436,,1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",628.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1233.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1041.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,1615.5,
"SINUS GUIDE CATHETER HANDLE SDKKLP",1570755,CDM,272,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"SINUS GUIDE CATHETER M-110",1570752,CDM,272,RC,,,OUTPATIENT,,,1795,1436,,1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",628.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1233.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1041.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,1615.5,
"SINUS ILLUMINATION SYSTEM SIS100B",1570750,CDM,272,RC,,,OUTPATIENT,,,2080,1664,,1768,85,,,,,0,"percent of total billed charges","85% of total billed charges",520,25,,,,,0,"percent of total billed charges","25% of total billed charges",520,25,,,,,0,"percent of total billed charges","25% of total billed charges",520,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",423.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1175.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1175.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1175.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1175.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1872,90,,,,,0,"percent of total billed charges","90% of total billed charges",728,35,,,,,0,"percent of total billed charges","35% of total billed charges",1428.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1872,90,,,,,0,"percent of total billed charges","90% of total billed charges",1206.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",423.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1768,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",423.7,1872,
"SINUS IRRIGATION CATHETER 22CM",1570756,CDM,272,RC,,,OUTPATIENT,,,615,492,,522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",153.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",153.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",153.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",553.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",215.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",422.51,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",553.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",356.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",125.28,553.5,
"SKIN STAPLER",7950068,CDM,272,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"SKIN STAPLER PMR35",7950177,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SKIN STAPLER PMW35",7950159,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SLEEVE KII Z THREAD CTS01",1570792,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SLEEVE KII Z THREAD CTS02",1570086,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SMOKE EVAC SYSTEM LAPROSCOPIC SEL7010",1570826,CDM,272,RC,,,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"SMOKE EVACUATION PENCIL NEPTUNE 000",1570805,CDM,272,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"SMOKE EVACUATION PENCIL NEPTUNE 004",1570807,CDM,272,RC,,,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",76.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"SNARE DISPOSABLE CAPTIVATOR II 6119",7905225,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SNARE DISPOSABLE CAPTIVATOR II 6129 XL",7905228,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SNARE DISPOSABLE SD210U25",7905162,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SPACE MAKER PRO COVIDIEN",7915719,CDM,272,RC,,,OUTPATIENT,,,1889,1511.2,,1605.65,85,,,,,0,"percent of total billed charges","85% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",384.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1700.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",661.15,35,,,,,0,"percent of total billed charges","35% of total billed charges",1297.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1700.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",1095.62,58,,,,,0,"percent of total billed charges","58% of total billed charges",384.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1605.65,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",384.79,1700.1,
"SPACE MAKER PRO COVIDIEN SMBTTOVLX",7950135,CDM,272,RC,,,OUTPATIENT,,,1889,1511.2,,1605.65,85,,,,,0,"percent of total billed charges","85% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",472.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",384.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1067.29,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1700.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",661.15,35,,,,,0,"percent of total billed charges","35% of total billed charges",1297.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1700.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",1095.62,58,,,,,0,"percent of total billed charges","58% of total billed charges",384.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1605.65,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",384.79,1700.1,
"SPYSCOPE DS ACCESS AND DELIVERY CATHETER",1750054,CDM,272,RC,,,OUTPATIENT,,,11270,9016,,9579.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2817.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2817.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2817.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2295.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10143,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7742.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10143,90,,,,,0,"percent of total billed charges","90% of total billed charges",6536.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",2295.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9579.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10143,
"STAPLE RELOADS",7950180,CDM,272,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"STAPLER CIRCULAR 29MM XL SEALED",7950397,CDM,272,RC,,,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",300,25,,,,,0,"percent of total billed charges","25% of total billed charges",300,25,,,,,0,"percent of total billed charges","25% of total billed charges",300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",244.44,1080,
"STAPLER CIRCULAR HEMORRHOIDAL PPH03",7950123,CDM,272,RC,,,OUTPATIENT,,,377.8,302.24,,321.13,85,,,,,0,"percent of total billed charges","85% of total billed charges",94.45,25,,,,,0,"percent of total billed charges","25% of total billed charges",94.45,25,,,,,0,"percent of total billed charges","25% of total billed charges",94.45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",213.46,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.46,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.46,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.46,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",340.02,90,,,,,0,"percent of total billed charges","90% of total billed charges",132.23,35,,,,,0,"percent of total billed charges","35% of total billed charges",259.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",340.02,90,,,,,0,"percent of total billed charges","90% of total billed charges",219.12,58,,,,,0,"percent of total billed charges","58% of total billed charges",76.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",321.13,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.96,340.02,
"STAPLER CONTOUR CURVED CUTTER CS40B",7950280,CDM,272,RC,,,OUTPATIENT,,,1700,1360,,1445,85,,,,,0,"percent of total billed charges","85% of total billed charges",425,25,,,,,0,"percent of total billed charges","25% of total billed charges",425,25,,,,,0,"percent of total billed charges","25% of total billed charges",425,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1530,90,,,,,0,"percent of total billed charges","90% of total billed charges",595,35,,,,,0,"percent of total billed charges","35% of total billed charges",1167.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1530,90,,,,,0,"percent of total billed charges","90% of total billed charges",986,58,,,,,0,"percent of total billed charges","58% of total billed charges",346.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1445,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.29,1530,
"STAPLER CONTOUR CURVED CUTTER CS40G",7950281,CDM,272,RC,,,OUTPATIENT,,,1700,1360,,1445,85,,,,,0,"percent of total billed charges","85% of total billed charges",425,25,,,,,0,"percent of total billed charges","25% of total billed charges",425,25,,,,,0,"percent of total billed charges","25% of total billed charges",425,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",960.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1530,90,,,,,0,"percent of total billed charges","90% of total billed charges",595,35,,,,,0,"percent of total billed charges","35% of total billed charges",1167.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1530,90,,,,,0,"percent of total billed charges","90% of total billed charges",986,58,,,,,0,"percent of total billed charges","58% of total billed charges",346.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1445,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.29,1530,
"STAPLER CONTOUR CUTTER RELOAD CR40B",7950282,CDM,272,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
"STAPLER CONTOUR CUTTER RELOAD CR40G",7950283,CDM,272,RC,,,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",63.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",51.94,229.5,
"STAPLER CURVED INTRALUMINAL ECS25A",7950288,CDM,272,RC,,,OUTPATIENT,,,1110,888,,943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",226.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",762.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",643.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",226.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",226.11,999,
"STAPLER CURVED INTRALUMINAL ECS25B",7950321,CDM,272,RC,,,OUTPATIENT,,,1110,888,,943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",226.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",762.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",643.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",226.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",226.11,999,
"STAPLER CURVED INTRALUMINAL ECS29A",7950289,CDM,272,RC,,,OUTPATIENT,,,1110,888,,943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",226.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",762.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",643.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",226.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",226.11,999,
"STAPLER CURVED INTRALUMINAL ECS33A",7950290,CDM,272,RC,,,OUTPATIENT,,,1030,824,,875.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",257.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",257.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",257.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",209.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",581.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",581.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",581.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",581.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",927,90,,,,,0,"percent of total billed charges","90% of total billed charges",360.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",707.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",927,90,,,,,0,"percent of total billed charges","90% of total billed charges",597.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",209.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",875.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",209.81,927,
"STAPLER PURSE STRING 65 MM",7950338,CDM,272,RC,,,OUTPATIENT,,,1175,940,,998.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",293.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",293.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",293.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",239.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1057.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",807.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1057.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",681.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",239.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",998.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",239.35,1057.5,
"STAPLER PURSTRING 45MM 020730",7950297,CDM,272,RC,,,OUTPATIENT,,,980,784,,833,85,,,,,0,"percent of total billed charges","85% of total billed charges",245,25,,,,,0,"percent of total billed charges","25% of total billed charges",245,25,,,,,0,"percent of total billed charges","25% of total billed charges",245,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",882,90,,,,,0,"percent of total billed charges","90% of total billed charges",343,35,,,,,0,"percent of total billed charges","35% of total billed charges",673.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",882,90,,,,,0,"percent of total billed charges","90% of total billed charges",568.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",833,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",199.63,882,
"STAPLER TA TA6035S",7950298,CDM,272,RC,,,OUTPATIENT,,,1635,1308,,1389.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",408.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",408.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",408.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",333.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",923.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",923.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",923.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",923.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1471.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",572.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1123.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1471.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",948.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",333.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1389.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",333.05,1471.5,
"STENT ADVANIX PRELOADED RX 10x5CM",1750038,CDM,272,RC,,,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"STENT ADVANIX PRELOADED RX 10x7CM",1750039,CDM,272,RC,,,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"STENT ADVANIX PRELOADED RX 10x9CM",1750040,CDM,272,RC,,,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"STENT ADVANIX PRELOADED RX 7x5CM",1750035,CDM,272,RC,,,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"STENT ADVANIX PRELOADED RX 7x7CM",1750036,CDM,272,RC,,,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"STENT ADVANIX PRELOADED RX 7x9CM",1750037,CDM,272,RC,,,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"STENT WALLFLEX BILIARY RX 10 X 40 8.5FR",1750052,CDM,272,RC,,,OUTPATIENT,,,11475,9180,,9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4016.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7883.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6655.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10327.5,
"STENT WALLFLEX BILIARY RX 10 X 60 8.5FR",1750057,CDM,272,RC,,,OUTPATIENT,,,11475,9180,,9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4016.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7883.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6655.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10327.5,
"STENT WALLFLEX BILIARY RX 10 X 80 8.5FR",1750062,CDM,272,RC,,,OUTPATIENT,,,11475,9180,,9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4016.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7883.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6655.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10327.5,
"STENT WALLFLEX ENTERAL COLONIC 30/25 X 6",1750047,CDM,272,RC,,,OUTPATIENT,,,11475,9180,,9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4016.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7883.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6655.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10327.5,
"STENT WALLFLEX ENTERAL COLONIC 30/25 X 9",1750048,CDM,272,RC,,,OUTPATIENT,,,11475,9180,,9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4016.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7883.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6655.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10327.5,
"STENT WALLFLEX ENTERAL COLONIC 30/25 X1",1750049,CDM,272,RC,,,OUTPATIENT,,,11475,9180,,9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2868.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4016.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7883.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10327.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6655.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2337.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9753.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10327.5,
"STENT WALLFLEX FULLY COVER ESOPH 10.5CM",1750063,CDM,272,RC,,,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,9315,
"STENT WALLFLEX FULLY COVER ESOPH 15.5CM",1750061,CDM,272,RC,,,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,9315,
"STERI DRAPE 1016",7905702,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"STERI STRIP 1 X 5 A1848",7905701,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STERI STRIP 1 X 5 R1548",7905700,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STERI STRIP 1/2 X 4 R1547",7905709,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STERI STRIP 1/4 X 3 R1541",7905474,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"STERI STRIP 1/4 X 3 R1551",7905475,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"STERI STRIP 1/4 X 4",7905471,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"STERI STRIP 1/8 X 3 R1540",7905708,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STERI U-DRAPE 1015",7905703,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"STETHOSCOPE ESOPHAGEAL",7950059,CDM,272,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"STYLET GLIDERITE",1570831,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"STYLET GLIDERITE SINGLE USE LARGE",1570889,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"STYLET GLIDERITE SINGLE USE MEDIUM",1570888,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"STYLET GLIDERITE SINGLE USE SMALL",1570887,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"STYLET GLIDERITE SU",1570850,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUCTION CATH KIT 10 FR. SAFE T VAC 37024",7907024,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CATH KIT 12 FR",7900028,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUCTION CATH KIT 12 FR. SAFE T VAC 37224",7900012,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CATH KIT 14 FR. SAFE T VAC 37424",7900014,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CATH KIT 6 FR. SAFE T VAC 36626",7900006,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUCTION CATH KIT 8 FR. SAFE T VAC 36826",7900008,CDM,272,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SUCTION CATH KIT GRADUATED CHIMNEY VALVE",7907025,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUCTION CATH Y ADAPTER NEONAT/PED 6 FR",7900007,CDM,272,RC,,,OUTPATIENT,,,603.72,482.98,,513.16,85,,,,,0,"percent of total billed charges","85% of total billed charges",150.93,25,,,,,0,"percent of total billed charges","25% of total billed charges",150.93,25,,,,,0,"percent of total billed charges","25% of total billed charges",150.93,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",122.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",341.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",543.35,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.3,35,,,,,0,"percent of total billed charges","35% of total billed charges",414.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",543.35,90,,,,,0,"percent of total billed charges","90% of total billed charges",350.16,58,,,,,0,"percent of total billed charges","58% of total billed charges",122.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",513.16,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",122.98,543.35,
"SUCTION CATHETER",7915702,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUCTION COAGULATOR 250510-FR",7905783,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SUCTION RESERVOIR CLOSED WOUND DRAIN",1570873,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SUCTION SLEEVE NEPTUNE 165MM",1570808,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUCTION SWAB ORAL CARE KIT AVANOS KIMVEN",7905805,CDM,272,RC,,,OUTPATIENT,,,12,9.6,,10.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",3,25,,,,,0,"percent of total billed charges","25% of total billed charges",3,25,,,,,0,"percent of total billed charges","25% of total billed charges",3,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",8.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.96,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.44,10.8,
"SUCTION SYSTEM CLOSED BALLARD 14 FR",7905804,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUCTION SYSTEM CLOSED CLEANING TPIECE 14",7900009,CDM,272,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"SUCTION SYSTEM CLOSED TURBO CLEANING",7905797,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SURGICEL 1/2 X 2 BTL",7905088,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SURGICEL 2 X 14",7905533,CDM,272,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"SURGICEL 2 X 3",7905529,CDM,272,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"SURGICEL 4 X 8 1952",7905099,CDM,272,RC,,,OUTPATIENT,,,400,320,,340,85,,,,,0,"percent of total billed charges","85% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",100,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",140,35,,,,,0,"percent of total billed charges","35% of total billed charges",274.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",232,58,,,,,0,"percent of total billed charges","58% of total billed charges",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",340,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",81.48,360,
"SURGICEL NUKNIT 3 X 4",7905534,CDM,272,RC,,,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",86.57,382.5,
"SURGIFLO WITH THROMBIN KIT",7905101,CDM,272,RC,,,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",393.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.16,1012.5,
"SURGIFOAM 8CM X 12.5CM X 1CM 1974",7905100,CDM,272,RC,,,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"SUTURE 0 CHROMIC 812H",1570500,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 0 CHROMIC 914H",1570501,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 CHROMIC L114G",1570502,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 0 CHROMIC U246H",1570503,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 0 ETHIBOND CX45D",1570504,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUTURE 0 ETHIBOND X412H",1570505,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 PDSII Z358T",1570653,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 PDSII Z370T",1570592,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 PROLENE 8418H",1570506,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 0 PROLENE 8454H",1570507,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 PROLENE C821G",1570600,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 0 PROLENE C845G",1570508,CDM,272,RC,,,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,418.5,
"SUTURE 0 SILK 678G",1570509,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 SILK 680H",1570608,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 SILK K834H",1570609,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 SILK SA66G",1570510,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 SILK SA76G",1570610,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 SURGILON BLACK BRAIDED 18IN",1570953,CDM,272,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"SUTURE 0 VICRYL J260H",1570512,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 VICRYL J346H",1570619,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 VICRYL J376H",1570513,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 VICRYL J381H",1570601,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 VICRYL J603H",1570514,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 0 VICRYL J906G",1570515,CDM,272,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"SUTURE 0 VICRYL J946H",1570511,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 0 VICRYL JJ81G",1570516,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 0 VICRYL VCPP81D",1570702,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 1 CHROMIC 3813G",1570517,CDM,272,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"SUTURE 1 PDSII Z359T",1570626,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 1 PDSII Z880G",1570518,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SUTURE 1 PROLENE 8435H",1570519,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 1 PROLENE 8455H",1570617,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 1 VICRYL J261H",1570520,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SUTURE 1 VICRYL J335H",1570521,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 1 VICRYL J765D",1570522,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 10-0 ETHILON 9061G",1570580,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SUTURE 2-0 CHROMIC 811H",1570524,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 2-0 CHROMIC G123H",1570525,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 2-0 CHROMIC L113G",1570526,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 2-0 CHROMIC U245H",1570523,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 2-0 ETHILON 1674H",1570527,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUTURE 2-0 ETHILON 585H",1570646,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PDS PLUS PDP317H",1570634,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PLAIN 843H",1570589,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PLAIN 853H",1570590,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 2-0 PLAIN L103G",1570528,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SUTURE 2-0 PLAIN N863H",1570529,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SUTURE 2-0 PROLENE 8411H",1570630,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PROLENE 8433H",1570604,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PROLENE 8559H",1570616,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SUTURE 2-0 PROLENE 8623H",1570614,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PROLENE 8685H",1570530,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PROLENE 8833H",1570615,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 PROLENE 8853H",1570541,CDM,272,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"SUTURE 2-0 SILK 1588H",1570607,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 SILK 685G",1570950,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 SILK 685H",1570531,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 SILK A185H",1570532,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 SILK C012D",1570533,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 2-0 SILK C016D",1570647,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 2-0 SILK K833H",1570534,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 VICRYL J111T",1570535,CDM,272,RC,,,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,265.5,
"SUTURE 2-0 VICRYL J259H",1570536,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 2-0 VICRYL J266J",1570537,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 2-0 VICRYL J306H",1570538,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 2-0 VICRYL J317H",1570606,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 VICRYL J339H",1570618,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 VICRYL J345H",1570625,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 VICRYL J417H",1570539,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 2-0 VICRYL J532H",1570540,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SUTURE 2-0 VICRYL J775D",1570620,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUTURE 2-0 VICRYL VCP762D",1570643,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 2-0 VLOC 90 GS-21 12",1570627,CDM,272,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SUTURE 2-0 VLOC 90 GS-22 6",1590954,CDM,272,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"SUTURE 2-0 VLOC 90 GS-22 9",1570629,CDM,272,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"SUTURE 3-0 CHROMIC 1638H",1570542,CDM,272,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"SUTURE 3-0 CHROMIC 810H",1570543,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 CHROMIC G122H",1570544,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 CHROMIC G122H",7950096,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SUTURE 3-0 CHROMIC GUT",1570545,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SUTURE 3-0 CHROMIC N877H",1570546,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 DEXON 760841",1570581,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUTURE 3-0 ETHILON 1663G",1570603,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 ETHILON 1663H",1570548,CDM,272,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"SUTURE 3-0 ETHILON 1669H",1570547,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 ETHILON 663G",1570562,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 MONOCRYL MCP416H",1570632,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 MONOCRYL VCP416H",1570701,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 MONOCRYL Y215H",1570649,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 MONOCRYL Y427H",1570612,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 MONOCRYL Y497G",1570641,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 PDS II Z416H",1570636,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 PDS PLUS PDP316H",1570635,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 PLAIN L102G",1570549,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 PLAIN N862H",1570550,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 3-0 PROLENE 38622",1570551,CDM,272,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"SUTURE 3-0 PROLENE 8663G",1570595,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 PROLENE 8684G",1570563,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 PROLENE 8832H",1570596,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 SILK 684G",1570552,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 SILK A184H",1570553,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 SILK C013D",1570554,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUTURE 3-0 SILK K832H",1570555,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VICRYL J110T",1570558,CDM,272,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"SUTURE 3-0 VICRYL J258H",1570559,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VICRYL J305H",1570622,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VICRYL J316H",1570557,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VICRYL J322H",1570560,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUTURE 3-0 VICRYL J356H",1570624,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VICRYL J416H",1570564,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VICRYL J423H",1570561,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SUTURE 3-0 VICRYL J683H",1570623,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 3-0 VICRYL J772D",1570621,CDM,272,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SUTURE 3-0 VICRYL J864D",1570652,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUTURE 3-0 VICRYL J980J",1570556,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 3-0 VICRYL RAPIDE VR497",1570654,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 3-0 VLOC 90 GS-21 9",1570628,CDM,272,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"SUTURE 4-0 CHROMIC 1637G",1570565,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUTURE 4-0 CHROMIC 1654G",1570594,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 4-0 CHROMIC U203H",1570613,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 DEXON 7608-31",1570566,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SUTURE 4-0 ETHILON 1667H",1570569,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 ETHILON 1854G",1570567,CDM,272,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SUTURE 4-0 ETHILON 662G",1570570,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 ETHILON 699G",1570568,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SUTURE 4-0 MONOCRYL MCP214H",1570656,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 MONOCRYL MCP513G",1570633,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 MONOCRYL Y214H",1570648,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 MONOCRYL Y415H",1570642,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 MONOCRYL Y426H",1570611,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 MONOCRYL Y464G",1570703,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 MONOCRYL Y496G",1570598,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SUTURE 4-0 PDS PLUS PDP513G",1570637,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 PLAIN 1604G",1570571,CDM,272,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"SUTURE 4-0 PLAIN 1828H",1570572,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 4-0 POLYSORB SL638",1570602,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 PROLENE 8557H",1570574,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SUTURE 4-0 PROLENE 8629H",1570575,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 4-0 PROLENE 8656G",1570930,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 PROLENE 8699G",1570573,CDM,272,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"SUTURE 4-0 SILK 683G",1570593,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 SILK C014D",1570597,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 4-0 VICRYL J214H",1570578,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 4-0 VICRYL J310H",1570579,CDM,272,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SUTURE 4-0 VICRYL J392H",1570584,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 4-0 VICRYL J415H",1570583,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 VICRYL J496G",1570952,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 VICRYL J496H",1570585,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 4-0 VICRYL J522H",1570576,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 4-0 VICRYL J845G",1570605,CDM,272,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SUTURE 4-0 VICRYL RAPIDE VR496",1570639,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 5-0 CHROMIC",7950009,CDM,272,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"SUTURE 5-0 CHROMIC 18 IN 792G",7905522,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"SUTURE 5-0 CHROMIC 18 IN VCP493G",7905524,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 5-0 CHROMIC 687G",7905516,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 5-0 DEXON 7608-21",7905638,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE 5-0 ETHILON 1661G PS-4 16MM",7905391,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 5-0 ETHILON 1668G",7905215,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 5-0 ETHILON 668G",1570400,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 5-0 ETHILON 695G 18 IN",7905627,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 5-0 ETHILON 698G",7905625,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 5-0 FAST ABSORB SURG GUT 1915G",1570951,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 5-0 MONOCRYL Y493G",1570577,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 5-0 PROLENE 8556H",1570582,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 5-0 PROLENE 8618G",1570591,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 5-0 PROLENE 8635G",1570588,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 5-0 PROLENE 8655G",1570940,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 5-0 PROLENE 8661G",7905597,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SUTURE 5-0 PROLENE 9702H",1570638,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"SUTURE 5-0 VICRYL J391H",7950038,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"SUTURE 6-0 ETHILON 1665G",1570587,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 6-0 ETHILON 660G",7905626,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE 6-0 PROLENE 8697G",1570586,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE 6-0 PROLENE 8697H",7905163,CDM,272,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"SUTURE 8-0 VICRYL J548G",1570599,CDM,272,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SUTURE ANCHOR BIOCOMP P-LCK 2.9MM",1570941,CDM,272,RC,,,OUTPATIENT,,,1855,1484,,1576.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",463.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",463.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",463.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",377.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1048.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1048.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1048.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1669.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",649.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1274.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1669.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1075.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",377.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1576.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",377.86,1669.5,
"SUTURE ANCHOR BIOCOMPOSITE SWIVEL LOCK",1570659,CDM,272,RC,,,OUTPATIENT,,,2102.4,1681.92,,1787.04,85,,,,,0,"percent of total billed charges","85% of total billed charges",525.6,25,,,,,0,"percent of total billed charges","25% of total billed charges",525.6,25,,,,,0,"percent of total billed charges","25% of total billed charges",525.6,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",428.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1187.86,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1187.86,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1187.86,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1187.86,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1892.16,90,,,,,0,"percent of total billed charges","90% of total billed charges",735.84,35,,,,,0,"percent of total billed charges","35% of total billed charges",1444.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1892.16,90,,,,,0,"percent of total billed charges","90% of total billed charges",1219.39,58,,,,,0,"percent of total billed charges","58% of total billed charges",428.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1787.04,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",428.26,1892.16,
"SUTURE CLIP LAPRA-TY ABSORB",1570631,CDM,272,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"SUTURE ENDOLOOP EZ10G",7950239,CDM,272,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SUTURE FIBERLINK",1570645,CDM,272,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"SUTURE LABRALTAPE WHITE 1.5MM 36IN",1570943,CDM,272,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"SUTURE LASSO PASSER 25DEG TIGHT CRV RT",1570942,CDM,272,RC,,,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",162.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",162.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",162.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",132.41,585,
"SUTURE O CHROMIC L114G",7905635,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SUTURE REMOVAL KIT",7905328,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE REMOVAL KIT 7160",7905333,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE REMOVAL KIT MDS708550",7905334,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUTURE TAPE 1.3 MM SUTURE W/ NEEDLE",1570867,CDM,272,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"SUTURE TAPE 1.3MM WH/BL & WH/BLK",1570644,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SUTURE TRAY",7905862,CDM,272,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SYRINGE INFLATION GAGE 60 ML",1750050,CDM,272,RC,,,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,594,
"TIGHT ROPE SYNDESMOSIS IMPLANT",1570877,CDM,272,RC,,,OUTPATIENT,,,8000,6400,,6800,85,,,,,0,"percent of total billed charges","85% of total billed charges",2000,25,,,,,0,"percent of total billed charges","25% of total billed charges",2000,25,,,,,0,"percent of total billed charges","25% of total billed charges",2000,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1629.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",7200,90,,,,,0,"percent of total billed charges","90% of total billed charges",2800,35,,,,,0,"percent of total billed charges","35% of total billed charges",5496,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7200,90,,,,,0,"percent of total billed charges","90% of total billed charges",4640,58,,,,,0,"percent of total billed charges","58% of total billed charges",1629.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6800,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1629.6,7200,
"TOURNIQUET CUFF 18IN STERILE",1570840,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TOURNIQUET CUFF 24IN STERILE",1570841,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TOURNIQUET CUFF 30IN STERILE",1570842,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TOURNIQUET CUFF 34IN STERILE",1570843,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TOURNIQUET CUFF 42IN STERILE",1570844,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TRACH CLEANING TRAY",7915002,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 2.5 86233 UNCUFFED",7905547,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 7.0",7905554,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRACHEAL TUBE 7.0 86051",7905607,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEAL TUBE 7.0 HIGH LOW INTERMED",7905608,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRACHEOSTOMY KIT PERCUTANEOUS DILATION",7905593,CDM,272,RC,,,OUTPATIENT,,,1175,940,,998.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",293.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",293.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",293.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",239.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1057.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",807.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1057.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",681.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",239.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",998.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",239.35,1057.5,
"TRACHEOSTOMY TUBE SZ 4 CFS",7905578,CDM,272,RC,,,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"TRACHEOSTOMY TUBE SZ 4 DFEN",7905574,CDM,272,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"TRACHEOSTOMY TUBE SZ 6 DCT",7905572,CDM,272,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"TRACHEOSTOMY TUBE SZ 6 DFEN",7905576,CDM,272,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"TRACHEOSTOMY TUBE SZ 8 DCT",7905573,CDM,272,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"TRACHEOSTOMY TUBE SZ 8DFEN",7905577,CDM,272,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"TRILINE WATER TRAP",7919128,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"TUBING 13FT SOFTOUCH INFILTRATION",7950343,CDM,272,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TUBING ARTHROSCOPY PUMP",1570815,CDM,272,RC,,,OUTPATIENT,,,300,240,,255,85,,,,,0,"percent of total billed charges","85% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",105,35,,,,,0,"percent of total billed charges","35% of total billed charges",206.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",174,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",255,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,270,
"TUBING HIGH FLOW ASPIRATION LF STERILE",7950342,CDM,272,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"TUBING HIGH FLOW BLACK AND BLACK B89200",7950337,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"TUBING INSUFFLATION 28-0212",7950087,CDM,272,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"TUBING SCOPE BUDDY PLUS OLYMPUS",7950350,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"TUBING SCOPE BUDDY PLUS OLYMPUS",7950391,CDM,272,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"TUBING SET UNIDRIVE ENT/OMFS",1570761,CDM,272,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"TUBING SOFT PUMP BLACK AND BLACK B89213",7950355,CDM,272,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"UNNA BOOT",7905083,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"UNNA FLEX",7905117,CDM,272,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"VACUTAINER LUERLOK ACCESS DEVICE",7950341,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VENT BREATHING CIRCUIT SET 260167",7919116,CDM,272,RC,,,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,,,,0,"percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,288,
"VENT CIRCUIT",7919103,CDM,272,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"VENT CIRCUIT SET DUAL LIMB HUD1607",791119,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VENT CIRCUIT SET STANDARD 1607",7919117,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VENT CIRCUIT UNIVERSAL NONHEATED MEDLINE",791120,CDM,272,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"VENT CIRCUIT W/ PARALLEL PATIENT Y",7919118,CDM,272,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"WAND COBLATION",1570770,CDM,272,RC,,,OUTPATIENT,,,620,496,,527,85,,,,,0,"percent of total billed charges","85% of total billed charges",155,25,,,,,0,"percent of total billed charges","25% of total billed charges",155,25,,,,,0,"percent of total billed charges","25% of total billed charges",155,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",126.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",350.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",350.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",350.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",350.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",558,90,,,,,0,"percent of total billed charges","90% of total billed charges",217,35,,,,,0,"percent of total billed charges","35% of total billed charges",425.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",558,90,,,,,0,"percent of total billed charges","90% of total billed charges",359.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",126.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",527,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",126.29,558,
"WOUND CLOSURE STRIP 1 X 5 TP1105",7905716,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"WOUND CLOSURE STRIP 1X5 STERILE",7905704,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XEROFORM 1  X 8",7905510,CDM,272,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"XEROFORM 1  X 8  CUR253180Z",7905511,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XEROFORM 5  X 9",7905520,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XEROFORM 5  X 9  CUR253590",7905521,CDM,272,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ANKLE BRACE AIRCAST LT (FIT/ADJ)",7905124,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,5.96,5.96,5.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"ANKLE BRACE AIRCAST RT (FIT/ADJ)",7905123,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,5.96,5.96,5.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"ANKLE BRACE LACER MEDLINE LG",7905383,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"ANKLE BRACE LG",7905158,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE BRACE LG 7981097",7905251,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE BRACE LG(INCLUDES FIT/ADJ) BRC6003",7905288,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE BRACE MD(INCLUDES FIT/ADJ) BRC6002",7905278,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE BRACE MED(INCLUDES FIT/ADJ)",7905160,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE BRACE NORCO AIR CELL(FIT/ADJUST)",7905125,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,5.96,5.96,5.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"ANKLE BRACE SM(INCLUDES FIT/ADJ) BRC6001",7905280,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE BRACE UNIVERSAL ELASTIC",7905381,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"ANKLE BRACE X-LG (INCLUDES FIT/ADJ)",7905161,CDM,274,RC,L1902,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE STIRRUP AIR STANDARD 10  1172PP",7905126,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,5.96,5.96,5.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"ANKLE STIRRUP AIR/GEL STAND 10  A152000",7905127,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,5.96,5.96,5.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"ANKLE STIRRUP STRAP W/ SLIP RING",7905138,CDM,274,RC,L4350,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,5.96,5.96,5.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ANKLE/FOOT ORTHOSIS 7839-01",5007130,CDM,274,RC,L1930,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"ARM IMMOBILIZER FEMALE (FIT/ADJ) LG",7905147,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER FEMALE SM. (FIX & ADJ)",7905149,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER MALE LG(INCLUDES FIT/ADJ",7905172,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"ARM IMMOBILIZER MALE X-L (FIT/ADJ)",7905148,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"BACK SUPPORT 2XL MEDLINE",7905811,CDM,274,RC,L0625,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.44,108,
"BACK SUPPORT L/XL MEDLINE",7905813,CDM,274,RC,L0625,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.44,108,
"BACK SUPPORT LARGE MEDLINE",7905812,CDM,274,RC,L0625,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.44,108,
"BRACE TAYLOR KNIGHT",7907173,CDM,274,RC,L0468,HCPCS,OUTPATIENT,,,2940,2352,,2499,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",598.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1533.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1533.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1533.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1533.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2646,90,,,,,0,"percent of total billed charges","90% of total billed charges",1029,35,,,,,0,"percent of total billed charges","35% of total billed charges",2019.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1705.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",598.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2499,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",598.88,2646,
"CERVICAL COLLAR LG",7905194,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CERVICAL COLLAR MED",7905193,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CERVICAL COLLAR MED LONG",7905113,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CERVICAL COLLAR ONE PIE 1.75X22 LOW",7905111,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CERVICAL COLLAR SM",7905192,CDM,274,RC,L0120,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,26.57,26.57,26.57,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CLAVICLE BRACE LG (FIT/ADJ)",7905217,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CLAVICLE BRACE MEDIUM (FIT/ADJ)",7905204,CDM,274,RC,L3671,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CLAVICLE BRACE SMALL(fitting/adj)",7905216,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CLAVICLE BRACE XLG (FIT/ADJ)",7905218,CDM,274,RC,L3671,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CLAVICLE BRACE XS (FIT/ADJ)",7905219,CDM,274,RC,L3650,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,29.69,29.69,29.69,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"KNEE BRACE LG  (INCLUDES FIT/ADJ)",7905266,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE BRACE MED (INCLUDES FIT/ADJ)",7905263,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE BRACE SM (INCLUDES FIT/ADJ)",7905261,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE BRACE UNIVERSAL",7905340,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE BRACE UNIVERSAL 12 IN",7905354,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE BRACE UNIVERSAL 16 IN",7905353,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE BRACE XL (FIT/ADJ)",7905264,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE SPLINT SUPER LARGE 20 IN",7905339,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"KNEE SPLINT SUPER MED 20 IN",7905338,CDM,274,RC,L1830,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",100.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.69,100,,39.20,39.20,39.20,"1 through 10","fee schedule","100% of CMS fee schedule",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.19,128.3,
"LUMBO SACRAL SUPPORT LG",7905776,CDM,274,RC,L0625,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",54.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.8,324,
"PELVIC SLING SAM II LARGE",7905337,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,280,224,,238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",98,35,,,,,0,"percent of total billed charges","35% of total billed charges",192.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,252,
"PELVIC SLING SAM II MEDIUM",7905336,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,280,224,,238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",98,35,,,,,0,"percent of total billed charges","35% of total billed charges",192.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,252,
"PELVIC SLING SAM II SMALL",7905335,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,280,224,,238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",98,35,,,,,0,"percent of total billed charges","35% of total billed charges",192.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,252,
"POST OP SHOE WOMENS LARGE",7905657,CDM,274,RC,L3260,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"RESTRAINT WRIST/ANKLE",7905313,CDM,274,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"RESTRAINT WRIST/ANKLE 2510",7905316,CDM,274,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RIB BELT MALE  ALL",7905307,CDM,274,RC,L0220,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"SPLINT ELBOW POSTERIOR PRE-FORMED",7900515,CDM,274,RC,L3999,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"SPLINT SAM 18  FLAT FOLD",7905369,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SPLINT SAM 36 FLAT FOLD",7905371,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"SPLINT SAM 36 ROLLED",7905372,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"SPLINT SAM FINGER",7905370,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,12,9.6,,10.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2.44,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",8.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.96,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.44,10.8,
"SPLINT WRIST LG LT (FIT & ADJ)",7905206,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST LG LT HOOK AND LOOP CLOSE",7905360,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST LG RT (FIT/ADJ)",7905205,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST LG RT W/ HOOK AND LOOP",7905318,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST MED LT (FIT/ADJ)",7905208,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST MED LT W/HOOK",7905114,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST PED/XS LEFT (FIT/ADJUST)",7905213,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SPLINT WRIST SM LT (FIT/ADJ)",7905209,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SPLINT WRIST SM RT (INCLUDES FIT/ADJ)",7905202,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SPLINT WRIST XL LT MEDLINE",7905388,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"SPLINT WRIST XL RT (FIT/ADJ)",7905211,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"SPLINT WRIST XL RT MEDLINE",7905387,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"ULTRASLING II LG (INCLUDES FRT & ADJ)",7905281,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"ULTRASLING III LG (INCLUDES FRT & ADJ)",7905303,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"ULTRASLING III MED (INCLUDES FRT & ADJ)",7905302,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"ULTRASLING III XL(INCLUDES FRT & ADJ)",7905304,CDM,274,RC,L3670,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"VALVE TRACHEOSTOMY SPEAKING",7905590,CDM,274,RC,L8501,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",171.1,265.5,
"WARMER TRANS INFANT MATTERESS",7905373,CDM,274,RC,L3908,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,23.52,23.52,32.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"LENS ANTERIOR CHAMBER 13.0",1570122,CDM,276,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,661.5,
"LENS ANTERIOR CHAMBER 15.5",1570117,CDM,276,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,661.5,
"LENS ANTERIOR CHAMBER 16.0",1570119,CDM,276,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,661.5,
"LENS ANTERIOR CHAMBER 17.5",1570118,CDM,276,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,661.5,
"LENS ANTERIOR CHAMBER 19.0",1570029,CDM,276,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,661.5,
"LENS ANTERIOR CHAMBER 20.0",1570121,CDM,276,RC,,,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,661.5,
"LENS INTRAOC HOYA  250 16.5",1570707,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOC HOYA  250 18.0",1570708,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOC HOYA  250 18.5",1570709,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOC HOYA  250 19.5",1570710,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOC HOYA  250 23.5",1570711,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOC HOYA  250 24.5",1570712,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR  6.0",1570090,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR  7.0",1570088,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR  8.5",1570091,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR  9.5",1570093,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 10.0",1570094,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 10.5",1570095,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 11.0",1570096,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 11.5",1570097,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 12.0",1570098,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 12.5",1570099,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 13.0",1570101,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 13.5",1570102,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 14.0",1570103,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 15.5",1570106,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 16.0",1570107,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 18.0",1570111,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 19.5",1570114,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 20.0",1570115,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 20.5",1570116,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 21.0",1570120,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 21.5",1570125,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 22.0",1570126,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 22.5",1570130,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 23.0",1570131,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 23.5",1570135,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 24.5",1570141,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 25.0",1570150,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 27.0",1570160,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 27.5",1570165,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 28.5",1570167,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 29.5",1570169,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 30.0",1570170,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 33.0",1570174,CDM,276,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,792,
"LENS INTRAOCULAR 34.0",1570173,CDM,276,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,792,
"LENS INTRAOCULAR 570C18.0",1570267,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C18.5",1570268,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C19.0",1570269,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C19.5",1570270,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C20.5",1570271,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C21.0",1570272,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C21.5",1570273,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C22.5",1570274,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C23.0",1570275,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C23.5",1570276,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C24.0",1570278,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C24.5",1570280,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C25.5",1570279,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR 570C29.5",1570277,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 11.0",1570723,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 11.5",1570724,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 12.0",1570725,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 12.5",1570726,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 13.0",1570727,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 13.5",1570728,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 14.0",1570729,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 14.5",1570730,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 15.0",1570731,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 15.5",1570732,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 16.0",1570733,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 16.5",1570734,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 17.0",1570735,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 17.5",1570736,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 18.0",1570737,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 18.5",1570738,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 19.0",1570739,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 19.5",1570740,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 20.0",1570741,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 20.5",1570742,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 21.0",1570743,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 21.5",1570744,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 22.0",1570775,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 22.5",1570776,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 23.0",1570777,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 23.5",1570778,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 24.0",1570779,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 24.5",1570780,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 25.0",1570781,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 25.5",1570782,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 26.0",1570783,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 26.5",1570784,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR AU00T0 27.0",1570785,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 11.50",1570321,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 14.50",1570327,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 16.00",1570330,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 18.50",1570331,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 19.00",1570333,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 19.50",1570335,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 20.00",1570332,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 21.00",1570334,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 21.50",1570337,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 22.00",1570336,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 22.50",1570338,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 23.00",1570339,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 23.50",1570340,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 24.00",1570341,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 24.50",1570342,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR HOYA 26.00",1570345,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L  5.0",1570300,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 18.5",1570301,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 20.5",1570302,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 21.0",1570303,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 21.5",1570304,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 22.5",1570305,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 24.5",1570306,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MI60L 25.5",1570307,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MN60AC 19.0",1570315,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MN60AC 21.0",1570319,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MN60MA 2.0",1570310,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR MN60MA 5.0",1570311,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR RESTOR SN6AD1 13.5",1570220,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1790,1432,,1521.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",447.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",447.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",447.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",933.86,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",933.86,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",933.86,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",933.86,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1611,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1229.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1611,90,,,,,0,"percent of total billed charges","90% of total billed charges",1038.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",364.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1521.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.62,1611,
"LENS INTRAOCULAR RESTOR SN6AD1 23.0",1570248,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,2100,1680,,1785,85,,,,,0,"percent of total billed charges","85% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1890,90,,,,,0,"percent of total billed charges","90% of total billed charges",735,35,,,,,0,"percent of total billed charges","35% of total billed charges",1442.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1890,90,,,,,0,"percent of total billed charges","90% of total billed charges",1218,58,,,,,0,"percent of total billed charges","58% of total billed charges",427.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1785,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.77,1890,
"LENS INTRAOCULAR RESTOR SN6AD1 23.5",1570251,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,2100,1680,,1785,85,,,,,0,"percent of total billed charges","85% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1095.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1890,90,,,,,0,"percent of total billed charges","90% of total billed charges",735,35,,,,,0,"percent of total billed charges","35% of total billed charges",1442.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1890,90,,,,,0,"percent of total billed charges","90% of total billed charges",1218,58,,,,,0,"percent of total billed charges","58% of total billed charges",427.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1785,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.77,1890,
"LENS INTRAOCULAR RESTOR SN6AD3 23.0",1570249,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,2215,1772,,1882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",451.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",775.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1521.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1284.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",451.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",451.2,1993.5,
"LENS INTRAOCULAR RESTOR SN6AD3 23.5",1570250,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,2215,1772,,1882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",451.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1155.59,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",775.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1521.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1284.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",451.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",451.2,1993.5,
"LENS INTRAOCULAR SN60AT 31.0",1570194,CDM,276,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,792,
"LENS INTRAOCULAR SN60AT 32.0",1570199,CDM,276,RC,,,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",220,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,792,
"LENS INTRAOCULAR SN60T3 21.0",1570175,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T3 21.5",1570176,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T4 15.5",1570193,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T4 21.0",1750175,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T4 24.5",1570189,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T4 29.5",1570192,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T5 12.5",1570191,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T5 19.0",1570177,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T5 22.0",1570188,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN60T5 29.0",1570190,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT3 13.0",1570283,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT3 19.0",1570284,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT3 19.5",1570287,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT3 21.5",1570285,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT3 22.0",1570286,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT4 13.0",1570208,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,972,
"LENS INTRAOCULAR SN6AT4 13.5",1570197,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,972,
"LENS INTRAOCULAR SN6AT4 14.5",1570198,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,972,
"LENS INTRAOCULAR SN6AT4 15.0",1570207,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,972,
"LENS INTRAOCULAR SN6AT4 19.0",1570195,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT4 21.5",1570206,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT4 22.5",1570205,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT4 27.5",1570210,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,972,
"LENS INTRAOCULAR SN6AT4 30.0",1570196,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6AT5 24.5",1570209,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,972,
"LENS INTRAOCULAR SN6AT8 21.5",1570288,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",351.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",733,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",491.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",286.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",286.2,1264.5,
"LENS INTRAOCULAR SN6CWS 7.5",1570655,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS 9.0",1570658,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS10.0",1570660,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS10.5",1570661,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS11.0",1570662,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS11.5",1570663,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS12.0",1570664,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS12.5",1570665,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS13.0",1570666,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS13.5",1570667,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS14.0",1570668,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS14.5",1570669,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS15.0",1570670,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS15.5",1570671,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS16.0",1570672,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS16.5",1570673,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS17.0",1570674,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS17.5",1570675,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS18.0",1570676,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS18.5",1570677,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS19.0",1570678,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS19.5",1570679,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS20.0",1570680,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS20.5",1570681,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS21.0",1570682,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS21.5",1570683,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS22.0",1570684,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS22.5",1570685,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS23.0",1570686,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS23.5",1570687,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS24.0",1570688,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS24.5",1570689,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS25.0",1570690,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS25.5",1570691,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS26.0",1570692,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS26.5",1570693,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS27.0",1570694,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS27.5",1570695,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS28.0",1570696,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS28.5",1570697,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS29.0",1570698,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS29.5",1570699,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR SN6CWS30.0",1570700,CDM,276,RC,,,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"LENS INTRAOCULAR ZCB0018.5",1570200,CDM,276,RC,,,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,738,
"LENS INTRAOCULAR ZCB0020.5",1570201,CDM,276,RC,,,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,738,
"LENS INTRAOCULAR ZCB0021.0",1570202,CDM,276,RC,,,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,738,
"LENS INTRAOCULAR ZCB0021.5",1570203,CDM,276,RC,,,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,738,
"LENS INTRAOCULAR ZCB0023.0",1570204,CDM,276,RC,,,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,738,
"LENS INTRAOCULAR ZMB0020.0",1570706,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1530,1224,,1300.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",311.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1377,90,,,,,0,"percent of total billed charges","90% of total billed charges",535.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1051.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1377,90,,,,,0,"percent of total billed charges","90% of total billed charges",887.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",311.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1300.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",311.66,1377,
"LENS INTRAOCULAR ZMB0020.5",1570705,CDM,276,RC,V2797,HCPCS,OUTPATIENT,,,1530,1224,,1300.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",311.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1377,90,,,,,0,"percent of total billed charges","90% of total billed charges",535.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1051.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1377,90,,,,,0,"percent of total billed charges","90% of total billed charges",887.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",311.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1300.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",311.66,1377,
"RING MALYUGIN 6.25mm",1570380,CDM,276,RC,,,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",199.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,513,
"XARACOLL (BUPIVICAINE) 300MG IMPLANT",2610156,CDM,278,RC,C9089,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1,130,,,,,0,"fee schedule","130% of CMS OPPS rate",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.79,102,,,,,0,"fee schedule","102% of CMS OPPS rate",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.7,90,,,,,0,"fee schedule","90% of CMS OPPS rate",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.01,760.5,
"ANCHORLOK 2.5MM",1570060,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1330,1064,,1130.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",332.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",332.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",332.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",270.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",693.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",693.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",693.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",693.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1197,90,,,,,0,"percent of total billed charges","90% of total billed charges",465.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",913.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1197,90,,,,,0,"percent of total billed charges","90% of total billed charges",771.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",270.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1130.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",270.92,1197,
"ANCHORS 8 TENDON",1570870,CDM,278,RC,29827,HCPCS,OUTPATIENT,,,2785,2228,,2367.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",696.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",696.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",696.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",567.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1452.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1452.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1452.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1452.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2506.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",974.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1913.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2506.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1615.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",567.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2367.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",567.3,2506.5,
"ANCHORS BONE 3 W ARTHRO DEL SYS ADVNCD",1570864,CDM,278,RC,29827,HCPCS,OUTPATIENT,,,1755,1404,,1491.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",438.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",438.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",438.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",357.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",614.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1205.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1017.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",357.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1491.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",357.49,1579.5,
"AUTO CELL PROCESS SYS",1511832,CDM,278,RC,C1832,HCPCS,OUTPATIENT,,,5000,4000,,4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2608.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2608.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2608.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2608.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",1750,35,,,,,0,"percent of total billed charges","35% of total billed charges",3435,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",2900,58,,,,,0,"percent of total billed charges","58% of total billed charges",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1018.5,4500,
"BONE SCREW HEX HEAD",7901060,CDM,278,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"CORTIVA 1MM ALLOGRAFT DERMIS 16 X 20CM",1570395,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,27935,22348,,23744.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6983.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",6983.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",6983.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5690.36,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14573.97,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",14573.97,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",14573.97,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",14573.97,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",25141.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9777.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",19191.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",25141.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16202.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",5690.36,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",23744.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5690.36,25141.5,
"DRILL 2.0",1570350,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"DRILL BIT 1.8MM 110MM W/ DEPTH MARK",1570132,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1530.24,1224.19,,1300.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",382.56,25,,,,,0,"percent of total billed charges","25% of total billed charges",382.56,25,,,,,0,"percent of total billed charges","25% of total billed charges",382.56,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",311.71,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",798.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",798.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1377.22,90,,,,,0,"percent of total billed charges","90% of total billed charges",535.58,35,,,,,0,"percent of total billed charges","35% of total billed charges",1051.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1377.22,90,,,,,0,"percent of total billed charges","90% of total billed charges",887.54,58,,,,,0,"percent of total billed charges","58% of total billed charges",311.71,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1300.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",311.71,1377.22,
"DRILL BIT 12MM",1570351,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,1075,860,,913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",268.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",376.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",738.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",623.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,967.5,
"DRILL BIT 2.0 CANNULATED",1570355,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,2030,1624,,1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",507.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",507.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",507.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1059.07,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1059.07,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1059.07,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1059.07,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",710.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1394.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",1177.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",413.51,1827,
"DRILL BIT 2.0 MM CALIBRATED",1570896,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,445,356,,378.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",111.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",111.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",111.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",90.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",400.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",155.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",305.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",400.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",258.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",90.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",378.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",90.65,400.5,
"DRILL BIT 2.5 MM",1570897,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,395,316,,335.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",98.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",98.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",80.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",355.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",138.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",271.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",355.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",80.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",335.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",80.46,355.5,
"DRILL BIT 2.5 MM QC 110 MM",1570026,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"DRILL BIT 2.5 MM QC GOLD 110 MM",1570025,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"DRILL BIT 2.7 MM",1570895,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,395,316,,335.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",98.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",98.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",98.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",80.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",355.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",138.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",271.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",355.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",80.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",335.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",80.46,355.5,
"DRILL BIT 2.7 MM THREE FLUTED QC 125 MM",1570027,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,594,
"DRILL BIT 3.0 CANNULATED TWIST",1570347,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,1755,1404,,1491.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",438.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",438.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",438.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",357.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",915.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",614.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1205.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1017.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",357.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1491.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",357.49,1579.5,
"EXPANDERS BREAST TISSUE SDC100H 225CC",1570832,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC110H 300CC",1570833,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC120H 375CC",1570810,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC-120UH",1570903,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC130H 475CC",1570812,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC-130UH",1570904,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC135H 500CC",1570834,CDM,278,RC,,,OUTPATIENT,,,14360,11488,,12206,85,,,,,0,"percent of total billed charges","85% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2925.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7491.76,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7491.76,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7491.76,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7491.76,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12924,90,,,,,0,"percent of total billed charges","90% of total billed charges",5026,35,,,,,0,"percent of total billed charges","35% of total billed charges",9865.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12924,90,,,,,0,"percent of total billed charges","90% of total billed charges",8328.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2925.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12206,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2925.13,12924,
"EXPANDERS BREAST TISSUE SDC-135UH",1570905,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC140H 600CC",1570811,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SDC150H 750CC",1570899,CDM,278,RC,,,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",3750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7825.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3055.5,13500,
"EXPANDERS BREAST TISSUE SMXP110RH",1570806,CDM,278,RC,,,OUTPATIENT,,,8210,6568,,6978.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2052.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2052.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2052.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1672.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7389,90,,,,,0,"percent of total billed charges","90% of total billed charges",2873.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5640.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7389,90,,,,,0,"percent of total billed charges","90% of total billed charges",4761.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1672.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6978.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1672.38,7389,
"EXPANDERS BREAST TISSUE SMXP130RH",1570813,CDM,278,RC,,,OUTPATIENT,,,7400,5920,,6290,85,,,,,0,"percent of total billed charges","85% of total billed charges",1850,25,,,,,0,"percent of total billed charges","25% of total billed charges",1850,25,,,,,0,"percent of total billed charges","25% of total billed charges",1850,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1507.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6660,90,,,,,0,"percent of total billed charges","90% of total billed charges",2590,35,,,,,0,"percent of total billed charges","35% of total billed charges",5083.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6660,90,,,,,0,"percent of total billed charges","90% of total billed charges",4292,58,,,,,0,"percent of total billed charges","58% of total billed charges",1507.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6290,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1507.38,6660,
"EXPANDERS BREAST TISSUE SMXP135RH",1570814,CDM,278,RC,,,OUTPATIENT,,,7400,5920,,6290,85,,,,,0,"percent of total billed charges","85% of total billed charges",1850,25,,,,,0,"percent of total billed charges","25% of total billed charges",1850,25,,,,,0,"percent of total billed charges","25% of total billed charges",1850,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1507.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3860.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6660,90,,,,,0,"percent of total billed charges","90% of total billed charges",2590,35,,,,,0,"percent of total billed charges","35% of total billed charges",5083.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6660,90,,,,,0,"percent of total billed charges","90% of total billed charges",4292,58,,,,,0,"percent of total billed charges","58% of total billed charges",1507.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6290,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1507.38,6660,
"EXPANDERS BREAST TISSUE SMXP150RH",1570809,CDM,278,RC,,,OUTPATIENT,,,8210,6568,,6978.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2052.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2052.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2052.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1672.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4283.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7389,90,,,,,0,"percent of total billed charges","90% of total billed charges",2873.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5640.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7389,90,,,,,0,"percent of total billed charges","90% of total billed charges",4761.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1672.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6978.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1672.38,7389,
"FIBULOCK IMPLANT SYSTEM",1570837,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3150,2520,,2677.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",787.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",787.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",787.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",641.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1643.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1643.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1643.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1643.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2835,90,,,,,0,"percent of total billed charges","90% of total billed charges",1102.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2164.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2835,90,,,,,0,"percent of total billed charges","90% of total billed charges",1827,58,,,,,0,"percent of total billed charges","58% of total billed charges",641.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2677.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",641.66,2835,
"GRAFT FLEXHD PLIA PERFOR THICK 1.5-2.2MM",1570375,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,15500,12400,,13175,85,,,,,0,"percent of total billed charges","85% of total billed charges",3875,25,,,,,0,"percent of total billed charges","25% of total billed charges",3875,25,,,,,0,"percent of total billed charges","25% of total billed charges",3875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3157.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13950,90,,,,,0,"percent of total billed charges","90% of total billed charges",5425,35,,,,,0,"percent of total billed charges","35% of total billed charges",10648.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13950,90,,,,,0,"percent of total billed charges","90% of total billed charges",8990,58,,,,,0,"percent of total billed charges","58% of total billed charges",3157.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13175,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3157.35,13950,
"GRAFT FLEXHD PLIA PERFOR THIN 17.5X20",1570377,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,49800,39840,,42330,85,,,,,0,"percent of total billed charges","85% of total billed charges",12450,25,,,,,0,"percent of total billed charges","25% of total billed charges",12450,25,,,,,0,"percent of total billed charges","25% of total billed charges",12450,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10144.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25981.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",25981.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",25981.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",25981.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",44820,90,,,,,0,"percent of total billed charges","90% of total billed charges",17430,35,,,,,0,"percent of total billed charges","35% of total billed charges",34212.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",44820,90,,,,,0,"percent of total billed charges","90% of total billed charges",28884,58,,,,,0,"percent of total billed charges","58% of total billed charges",10144.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42330,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10144.26,44820,
"GRAFT FLEXHD PLIA PERFOR THIN 8X16",1570374,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,15500,12400,,13175,85,,,,,0,"percent of total billed charges","85% of total billed charges",3875,25,,,,,0,"percent of total billed charges","25% of total billed charges",3875,25,,,,,0,"percent of total billed charges","25% of total billed charges",3875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3157.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8086.51,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",13950,90,,,,,0,"percent of total billed charges","90% of total billed charges",5425,35,,,,,0,"percent of total billed charges","35% of total billed charges",10648.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13950,90,,,,,0,"percent of total billed charges","90% of total billed charges",8990,58,,,,,0,"percent of total billed charges","58% of total billed charges",3157.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13175,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3157.35,13950,
"GRAFT FLEXHD PLIA PERFOR THIN 8X20",1570373,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,21200,16960,,18020,85,,,,,0,"percent of total billed charges","85% of total billed charges",5300,25,,,,,0,"percent of total billed charges","25% of total billed charges",5300,25,,,,,0,"percent of total billed charges","25% of total billed charges",5300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4318.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11060.25,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",11060.25,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",11060.25,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",11060.25,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",19080,90,,,,,0,"percent of total billed charges","90% of total billed charges",7420,35,,,,,0,"percent of total billed charges","35% of total billed charges",14564.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19080,90,,,,,0,"percent of total billed charges","90% of total billed charges",12296,58,,,,,0,"percent of total billed charges","58% of total billed charges",4318.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18020,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4318.44,19080,
"GRAFT FLEXHD PLIABLE SHAPED THIN XL",1570379,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,30330,24264,,25780.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7582.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7582.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7582.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6178.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",15823.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",15823.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",15823.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",15823.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",27297,90,,,,,0,"percent of total billed charges","90% of total billed charges",10615.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20836.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27297,90,,,,,0,"percent of total billed charges","90% of total billed charges",17591.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6178.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25780.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6178.22,27297,
"GRAFT WOUND MATRIX INTEGRA MESHED",1570376,CDM,278,RC,Q4100,HCPCS,OUTPATIENT,,,15758,12606.4,,13394.3,85,,,,,0,"percent of total billed charges","85% of total billed charges",3939.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3939.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3939.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3209.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8221.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8221.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8221.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8221.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",14182.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",5515.3,35,,,,,0,"percent of total billed charges","35% of total billed charges",10825.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14182.2,90,,,,,0,"percent of total billed charges","90% of total billed charges",9139.64,58,,,,,0,"percent of total billed charges","58% of total billed charges",3209.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13394.3,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3209.9,14182.2,
"GRAFTJACKET MATRIX 2 x 4",1570056,CDM,278,RC,Q4107,HCPCS,OUTPATIENT,,,4370,3496,,3714.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",890.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",3933,90,,,,,0,"percent of total billed charges","90% of total billed charges",1529.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3002.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3933,90,,,,,0,"percent of total billed charges","90% of total billed charges",2534.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",890.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3714.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",890.17,3933,
"HERNIA BARD MESH 1 X 4",7950213,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,135,108,,114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",33.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",92.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",114.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.5,121.5,
"HERNIA BARD MESH 3 X 6 0112680",7950233,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"HERNIA BARD MESH 6 X 6 0112720",7950302,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"HERNIA COMPOSIX E/X MESH 0123680",1570046,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,3240,2592,,2754,85,,,,,0,"percent of total billed charges","85% of total billed charges",810,25,,,,,0,"percent of total billed charges","25% of total billed charges",810,25,,,,,0,"percent of total billed charges","25% of total billed charges",810,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",659.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1690.34,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1690.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1690.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1690.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2916,90,,,,,0,"percent of total billed charges","90% of total billed charges",1134,35,,,,,0,"percent of total billed charges","35% of total billed charges",2225.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2916,90,,,,,0,"percent of total billed charges","90% of total billed charges",1879.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",659.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2754,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",659.99,2916,
"HERNIA COMPOSIX L/P MESH 0134680",1570047,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,3240,2592,,2754,85,,,,,0,"percent of total billed charges","85% of total billed charges",810,25,,,,,0,"percent of total billed charges","25% of total billed charges",810,25,,,,,0,"percent of total billed charges","25% of total billed charges",810,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",659.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1690.34,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1690.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1690.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1690.34,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2916,90,,,,,0,"percent of total billed charges","90% of total billed charges",1134,35,,,,,0,"percent of total billed charges","35% of total billed charges",2225.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2916,90,,,,,0,"percent of total billed charges","90% of total billed charges",1879.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",659.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2754,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",659.99,2916,
"HERNIA ECHO 2 POSITIONING SYSTEM 5990011",1570381,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2985,2388,,2537.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",746.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",746.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",746.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",608.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1557.3,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1557.3,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1557.3,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1557.3,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2686.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1044.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2050.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2686.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1731.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",608.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2537.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",608.04,2686.5,
"HERNIA ECHO 2 POSITIONING SYSTEM 5990015",1570059,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,4245,3396,,3608.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1061.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1061.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1061.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",864.71,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2214.66,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",2214.66,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2214.66,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2214.66,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",3820.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1485.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2916.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3820.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2462.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",864.71,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3608.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",864.71,3820.5,
"HERNIA ECHO 2 POSITIONING SYSTEM 5991015",1570382,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2645,2116,,2248.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",661.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",661.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",661.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",538.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1379.92,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1379.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1379.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1379.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2380.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",925.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1817.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2380.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1534.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",538.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2248.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",538.79,2380.5,
"HERNIA ECHO 2 POSITIONING SYSTEM 5991520",1570384,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,5150,4120,,4377.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1287.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1287.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1287.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1049.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2686.81,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",2686.81,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2686.81,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2686.81,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4635,90,,,,,0,"percent of total billed charges","90% of total billed charges",1802.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3538.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4635,90,,,,,0,"percent of total billed charges","90% of total billed charges",2987,58,,,,,0,"percent of total billed charges","58% of total billed charges",1049.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4377.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1049.06,4635,
"HERNIA ECHO 2 POSITIONING SYSTEM 5992025",1570383,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,8905,7124,,7569.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1813.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4645.83,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",4645.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4645.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4645.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",8014.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3116.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6117.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8014.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5164.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1813.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7569.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1813.95,8014.5,
"HERNIA ECHO 2 POSITIONING SYSTEM 5992533",1570386,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,11060,8848,,9401,85,,,,,0,"percent of total billed charges","85% of total billed charges",2765,25,,,,,0,"percent of total billed charges","25% of total billed charges",2765,25,,,,,0,"percent of total billed charges","25% of total billed charges",2765,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2252.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5770.11,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",5770.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",5770.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",5770.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",9954,90,,,,,0,"percent of total billed charges","90% of total billed charges",3871,35,,,,,0,"percent of total billed charges","35% of total billed charges",7598.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9954,90,,,,,0,"percent of total billed charges","90% of total billed charges",6414.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2252.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9401,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2252.92,9954,
"HERNIA MESH DEXTILE DXT1309AL MED LT",1570396,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,607.5,
"HERNIA MESH DEXTILE DXT1309AR MED RT",1570394,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,630,504,,535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",157.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",432.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,567,
"HERNIA MESH DEXTILE DXT1510AL LG LT",1570387,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,607.5,
"HERNIA MESH DEXTILE DXT1510AR LG RT",1570399,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",168.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,607.5,
"HERNIA MESH DEXTILE DXT1612AL XL LEFT",1570361,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,720,576,,612,85,,,,,0,"percent of total billed charges","85% of total billed charges",180,25,,,,,0,"percent of total billed charges","25% of total billed charges",180,25,,,,,0,"percent of total billed charges","25% of total billed charges",180,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",146.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",648,90,,,,,0,"percent of total billed charges","90% of total billed charges",252,35,,,,,0,"percent of total billed charges","35% of total billed charges",494.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",648,90,,,,,0,"percent of total billed charges","90% of total billed charges",417.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",146.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",612,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,648,
"HERNIA MESH DEXTILE DXT1612AR XL RIGHT",1570362,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,675,
"HERNIA MESH LARGE RIGHT 3D MAX 0115321",1570064,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",202.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",202.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",202.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,729,
"HERNIA MESH LG LEFT 3D MAX 0115311",1570062,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",202.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",202.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",202.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,729,
"HERNIA MESH MED LEFT 3D MAX 0115310",1570061,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,765,612,,650.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",155.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",688.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",267.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",525.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",688.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",443.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",155.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",650.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,688.5,
"HERNIA MESH MED RIGHT 3D MAX 0115320",1570063,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,765,612,,650.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",191.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",155.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",688.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",267.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",525.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",688.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",443.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",155.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",650.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,688.5,
"HERNIA MESH PHASIX ST 1200710",1570388,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,6950,5560,,5907.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1737.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1737.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1737.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1415.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3625.88,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",3625.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3625.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3625.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6255,90,,,,,0,"percent of total billed charges","90% of total billed charges",2432.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4774.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6255,90,,,,,0,"percent of total billed charges","90% of total billed charges",4031,58,,,,,0,"percent of total billed charges","58% of total billed charges",1415.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5907.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1415.72,6255,
"HERNIA MESH PHASIX ST 1201520",1570389,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,25750,20600,,21887.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5245.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",13434.03,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",13434.03,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",13434.03,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",13434.03,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",23175,90,,,,,0,"percent of total billed charges","90% of total billed charges",9012.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",17690.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23175,90,,,,,0,"percent of total billed charges","90% of total billed charges",14935,58,,,,,0,"percent of total billed charges","58% of total billed charges",5245.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21887.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5245.28,23175,
"HERNIA MESH SRGPRO 2CM PLUG SMPM-02",1570366,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"HERNIA MESH SRGPRO PLUG SMPL-01",1570367,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,345,276,,293.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",86.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",86.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",86.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",70.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",310.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",120.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",237.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",310.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",200.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",70.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",293.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",70.28,310.5,
"HERNIA PARIETENE COMPOSITE MESH PPDS12",1570397,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1385,1108,,1177.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",282.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",722.57,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1246.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",951.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1246.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",803.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",282.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1177.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",282.12,1246.5,
"HERNIA PARIETENE COMPOSITE MESH PPDS15",1570391,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1706,1364.8,,1450.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",426.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",426.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",426.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",347.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",890.04,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",890.04,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",890.04,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",890.04,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1535.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",597.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",1172.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1535.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",989.48,58,,,,,0,"percent of total billed charges","58% of total billed charges",347.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1450.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",347.51,1535.4,
"HERNIA PARIETENE COMPOSITE MESH PPDS1510",1570390,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1385,1108,,1177.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",282.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",722.57,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1246.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",951.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1246.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",803.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",282.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1177.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",282.12,1246.5,
"HERNIA PARIETENE COMPOSITE MESH PPDS2015",1570392,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2025,1620,,1721.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",506.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",506.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",506.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",412.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1056.46,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1056.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1056.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1056.46,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1822.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",708.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1391.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1822.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1174.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",412.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1721.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",412.49,1822.5,
"HERNIA PARIETENE COMPOSITE MESH PPDS2520",1570401,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,4635,3708,,3939.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",944.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2418.13,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",2418.13,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2418.13,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2418.13,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4171.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1622.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3184.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4171.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2688.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",944.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3939.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",944.15,4171.5,
"HERNIA PARIETENE COMPOSITE MESH PPDS3020",1570393,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,4635,3708,,3939.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",944.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2418.13,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",2418.13,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2418.13,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2418.13,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4171.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1622.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3184.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4171.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2688.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",944.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3939.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",944.15,4171.5,
"HERNIA PATCH",1570005,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2870,2296,,2439.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",717.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",717.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",584.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1497.31,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1497.31,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1497.31,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1497.31,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2583,90,,,,,0,"percent of total billed charges","90% of total billed charges",1004.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1971.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2583,90,,,,,0,"percent of total billed charges","90% of total billed charges",1664.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",584.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2439.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",584.62,2583,
"HERNIA PATCH",7950083,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2870,2296,,2439.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",717.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",717.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",584.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1497.31,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1497.31,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1497.31,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1497.31,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2583,90,,,,,0,"percent of total billed charges","90% of total billed charges",1004.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1971.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2583,90,,,,,0,"percent of total billed charges","90% of total billed charges",1664.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",584.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2439.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",584.62,2583,
"HERNIA PATCH KUGEL 3 X 3",1570006,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 3 X 3",7905226,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 3 X 4.6",1570007,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 3 X 4.6",7905157,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 4.34 X 5.5",1570008,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 4.34 X 5.5",7902000,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 5.5 X 7",7902001,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PATCH KUGEL 5.5 X 7 0010102",1570009,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1490,1192,,1266.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",372.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",372.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",372.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",303.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",777.35,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",777.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",777.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",777.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1341,90,,,,,0,"percent of total billed charges","90% of total billed charges",521.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1023.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1341,90,,,,,0,"percent of total billed charges","90% of total billed charges",864.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",303.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1266.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",303.51,1341,
"HERNIA PATCH PARIETEX COMPO 4.6CM PCO4VP",1570363,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1215,972,,1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",303.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",303.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",303.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",633.88,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1093.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",425.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",834.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1093.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",704.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",247.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,1093.5,
"HERNIA PATCH PARIETEX COMPO 6.6CM PCO6VP",1570364,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1455,1164,,1236.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",363.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",363.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",296.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",759.09,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",759.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",759.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",759.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",509.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",999.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",843.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",296.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1236.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",296.38,1309.5,
"HERNIA PATCH PARIETEX COMPO 8.6CM PCO8VP",1570365,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1870,1496,,1589.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",467.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",467.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",467.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",380.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",975.6,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",975.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",975.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",975.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1683,90,,,,,0,"percent of total billed charges","90% of total billed charges",654.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1284.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1683,90,,,,,0,"percent of total billed charges","90% of total billed charges",1084.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",380.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1589.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",380.92,1683,
"HERNIA PATCH PROCEED VENTRAL PVPM",1570054,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2075,1660,,1763.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",518.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",518.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",518.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",422.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1082.55,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1082.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1082.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1082.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1867.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",726.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1425.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1867.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1203.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",422.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1763.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",422.68,1867.5,
"HERNIA PATCH PROCEED VENTRAL PVPS",1570053,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1730,1384,,1470.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",432.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",432.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",432.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",352.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",902.56,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",902.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",902.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",902.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1557,90,,,,,0,"percent of total billed charges","90% of total billed charges",605.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1188.51,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1557,90,,,,,0,"percent of total billed charges","90% of total billed charges",1003.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",352.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1470.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",352.4,1557,
"HERNIA PATCH VENTRALEX ST 6.4CM 5950008",1570057,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2285,1828,,1942.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",571.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",465.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1192.11,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1192.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1192.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1192.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2056.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",799.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1569.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2056.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1325.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",465.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1942.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",465.45,2056.5,
"HERNIA PATCH VENTRALEX ST 8CM 5950009",1570058,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,3085,2468,,2622.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",771.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",771.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",771.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",628.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1609.48,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1609.48,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1609.48,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1609.48,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2776.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1079.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2119.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2776.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1789.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",628.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2622.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",628.41,2776.5,
"HERNIA PERFIX PLUG 0112760",1570010,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,684,
"HERNIA PERFIX PLUG 0112760",7950240,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PERFIX PLUG 0112770",1570011,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,603,
"HERNIA PERFIX PLUG 0112770",7950241,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PERFIX PLUG 0112780",1570004,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA PERFIX PLUG 0112780",1570012,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,840,672,,714,85,,,,,0,"percent of total billed charges","85% of total billed charges",210,25,,,,,0,"percent of total billed charges","25% of total billed charges",210,25,,,,,0,"percent of total billed charges","25% of total billed charges",210,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",294,35,,,,,0,"percent of total billed charges","35% of total billed charges",577.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",487.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",714,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,756,
"HERNIA SURGIMESH WN T1015",1570052,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1625,1300,,1381.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",406.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",406.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",406.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",331.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",847.78,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",847.78,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",847.78,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",847.78,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1462.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",568.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1116.38,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1462.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",942.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",331.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1381.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",331.01,1462.5,
"HERNIA SURGIMESH WN T1115-8",1570049,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,2010,1608,,1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",502.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1048.64,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1048.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",703.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1380.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1809,90,,,,,0,"percent of total billed charges","90% of total billed charges",1165.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",409.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1708.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.44,1809,
"HERNIA SURGIMESH XB",1570048,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,6205,4964,,5274.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1551.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1551.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1551.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1263.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3237.21,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",3237.21,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3237.21,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3237.21,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",5584.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2171.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4262.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5584.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3598.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1263.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5274.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1263.96,5584.5,
"HERNIA SYMBOTEX COMPOSITE MESH SYM12",1570398,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1385,1108,,1177.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",346.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",282.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",722.57,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",722.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1246.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",951.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1246.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",803.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",282.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1177.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",282.12,1246.5,
"HERNIA SYMBOTEX MESH SYM9",1570358,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,979.56,783.65,,832.63,85,,,,,0,"percent of total billed charges","85% of total billed charges",244.89,25,,,,,0,"percent of total billed charges","25% of total billed charges",244.89,25,,,,,0,"percent of total billed charges","25% of total billed charges",244.89,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",199.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,241.26,216.02,337.75,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",881.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",342.85,35,,,,,0,"percent of total billed charges","35% of total billed charges",672.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",881.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",568.14,58,,,,,0,"percent of total billed charges","58% of total billed charges",199.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.63,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,881.6,
"HERNIA SYSTEM PROLENE LARGE PHSL",1570067,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1420,1136,,1207,85,,,,,0,"percent of total billed charges","85% of total billed charges",355,25,,,,,0,"percent of total billed charges","25% of total billed charges",355,25,,,,,0,"percent of total billed charges","25% of total billed charges",355,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",289.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",740.83,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",740.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",740.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",740.83,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1278,90,,,,,0,"percent of total billed charges","90% of total billed charges",497,35,,,,,0,"percent of total billed charges","35% of total billed charges",975.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1278,90,,,,,0,"percent of total billed charges","90% of total billed charges",823.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",289.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1207,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",289.25,1278,
"HERNIA SYSTEM PROLENE MEDIUM PHSM6",1570066,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,1260,1008,,1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",315,25,,,,,0,"percent of total billed charges","25% of total billed charges",315,25,,,,,0,"percent of total billed charges","25% of total billed charges",315,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",657.35,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",657.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",657.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",657.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1134,90,,,,,0,"percent of total billed charges","90% of total billed charges",441,35,,,,,0,"percent of total billed charges","35% of total billed charges",865.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1134,90,,,,,0,"percent of total billed charges","90% of total billed charges",730.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",256.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.66,1134,
"HERNIA XENMATRIX AB SURGICAL GRAFT",1570385,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,5150,4120,,4377.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1287.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1287.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1287.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1049.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2686.81,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",2686.81,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2686.81,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2686.81,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4635,90,,,,,0,"percent of total billed charges","90% of total billed charges",1802.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3538.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4635,90,,,,,0,"percent of total billed charges","90% of total billed charges",2987,58,,,,,0,"percent of total billed charges","58% of total billed charges",1049.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4377.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1049.06,4635,
"IMPLANT BIOINDUCTIVE W/ARTH DEL MED",1570857,CDM,278,RC,,,OUTPATIENT,,,11755,9404,,9991.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2938.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2938.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2938.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2394.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",6132.7,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6132.7,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6132.7,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6132.7,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",10579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4114.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8075.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6817.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2394.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9991.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2394.49,10579.5,
"IMPLANT BREAST MEMORYGEL ENHANCE SUHE930",1571265,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,13800,11040,,11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7199.6,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",4830,35,,,,,0,"percent of total billed charges","35% of total billed charges",9480.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",8004,58,,,,,0,"percent of total billed charges","58% of total billed charges",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,12420,
"IMPLANT BREAST MEMORYGEL SUHE1030",1571266,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,13800,11040,,11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7199.6,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",4830,35,,,,,0,"percent of total billed charges","35% of total billed charges",9480.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",8004,58,,,,,0,"percent of total billed charges","58% of total billed charges",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,12420,
"IMPLANT BREAST MEMORYGEL SUHE1135",1571267,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,13800,11040,,11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7199.6,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",4830,35,,,,,0,"percent of total billed charges","35% of total billed charges",9480.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",8004,58,,,,,0,"percent of total billed charges","58% of total billed charges",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,12420,
"IMPLANT BREAST MEMORYGEL SUHE1240",1571268,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,13800,11040,,11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",3450,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7199.6,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7199.6,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",4830,35,,,,,0,"percent of total billed charges","35% of total billed charges",9480.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12420,90,,,,,0,"percent of total billed charges","90% of total billed charges",8004,58,,,,,0,"percent of total billed charges","58% of total billed charges",2811.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11730,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2811.06,12420,
"IMPLANT BREAST SMTH RND HIGH PROF",1571251,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571252,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571253,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571254,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571255,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571256,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571257,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571258,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571259,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571263,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571264,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND HIGH PROF",1571275,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1580,1264,,1343,85,,,,,0,"percent of total billed charges","85% of total billed charges",395,25,,,,,0,"percent of total billed charges","25% of total billed charges",395,25,,,,,0,"percent of total billed charges","25% of total billed charges",395,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",321.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",824.3,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",824.3,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",824.3,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",824.3,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1422,90,,,,,0,"percent of total billed charges","90% of total billed charges",553,35,,,,,0,"percent of total billed charges","35% of total billed charges",1085.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1422,90,,,,,0,"percent of total billed charges","90% of total billed charges",916.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",321.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1343,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",321.85,1422,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571007,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571008,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571009,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571010,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571011,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571012,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571013,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571014,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571015,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571016,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571017,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571018,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571019,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571020,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571021,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF BOOST",1571022,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570990,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570991,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570992,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570993,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570994,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570995,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570996,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570997,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570998,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1570999,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571000,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571001,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571002,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571003,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571004,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571005,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571006,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571023,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571045,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571046,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571047,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571048,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571049,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571051,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571052,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571053,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571054,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571055,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571056,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571057,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571058,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571059,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571060,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571062,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND HIGH PROF XTRA",1571561,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571238,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571239,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571240,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571241,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571242,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571243,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571244,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571245,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571246,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571247,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571248,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571249,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571250,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PLUS PROF",1571260,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,2800,2240,,2380,85,,,,,0,"percent of total billed charges","85% of total billed charges",700,25,,,,,0,"percent of total billed charges","25% of total billed charges",700,25,,,,,0,"percent of total billed charges","25% of total billed charges",700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",570.36,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1460.79,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",1460.79,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1460.79,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1460.79,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2520,90,,,,,0,"percent of total billed charges","90% of total billed charges",980,35,,,,,0,"percent of total billed charges","35% of total billed charges",1923.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2520,90,,,,,0,"percent of total billed charges","90% of total billed charges",1624,58,,,,,0,"percent of total billed charges","58% of total billed charges",570.36,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2380,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",570.36,2520,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571029,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571030,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571031,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571032,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571033,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571034,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571035,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571036,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571037,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571038,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571039,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571040,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571041,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571044,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571069,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571071,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571075,CDM,278,RC,,,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF BOOST",1571076,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8800,7040,,7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",2200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4591.05,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4591.05,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",3080,35,,,,,0,"percent of total billed charges","35% of total billed charges",6045.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7920,90,,,,,0,"percent of total billed charges","90% of total billed charges",5104,58,,,,,0,"percent of total billed charges","58% of total billed charges",1792.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7480,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1792.56,7920,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",151140,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571123,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571124,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571125,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571126,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571127,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571128,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571129,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571130,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571131,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571132,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571133,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571134,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571135,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571136,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571137,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571138,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571139,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571141,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571142,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571143,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571144,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF CLASSIC",1571145,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571080,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571081,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571082,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571083,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571084,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571085,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571086,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571087,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571088,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571089,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571090,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND MOD PROF XTRA",1571091,CDM,278,RC,,,OUTPATIENT,,,8200,6560,,6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",2050,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4278.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",2870,35,,,,,0,"percent of total billed charges","35% of total billed charges",5633.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7380,90,,,,,0,"percent of total billed charges","90% of total billed charges",4756,58,,,,,0,"percent of total billed charges","58% of total billed charges",1670.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6970,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1670.34,7380,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571221,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571222,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571226,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571227,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571228,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571229,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571230,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571231,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571232,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571233,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571234,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571235,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571236,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571237,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571261,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT BREAST SMTH RND ULTRA HIGH",1571262,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,6800,5440,,5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",1700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3547.63,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3547.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",2380,35,,,,,0,"percent of total billed charges","35% of total billed charges",4671.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6120,90,,,,,0,"percent of total billed charges","90% of total billed charges",3944,58,,,,,0,"percent of total billed charges","58% of total billed charges",1385.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5780,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1385.16,6120,
"IMPLANT HAMMERTOE KIT",1570028,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,6930,5544,,5890.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1732.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1732.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1732.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1411.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3615.45,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3615.45,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3615.45,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3615.45,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6237,90,,,,,0,"percent of total billed charges","90% of total billed charges",2425.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4760.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6237,90,,,,,0,"percent of total billed charges","90% of total billed charges",4019.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1411.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5890.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1411.64,6237,
"IMPLANT HAMMERTOE KIT",1570187,CDM,278,RC,C1776,HCPCS,OUTPATIENT,,,4370,3496,,3714.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",890.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2279.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",3933,90,,,,,0,"percent of total billed charges","90% of total billed charges",1529.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3002.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3933,90,,,,,0,"percent of total billed charges","90% of total billed charges",2534.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",890.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3714.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",890.17,3933,
"IMPLANT HERNIA  PERMACOL 15CM X 20CM",1570368,CDM,278,RC,C1781,HCPCS,OUTPATIENT,,,13905,11124,,11819.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3476.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3476.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3476.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2832.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7254.38,52.17,,241.26,216.02,337.75,"1 through 10","percent of total billed charges","52.17% of total billed charges",7254.38,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7254.38,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7254.38,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12514.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4866.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9552.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12514.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8064.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2832.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11819.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2832.45,12514.5,
"IMPLANT LPT REGULAR GREAT TOE SZ 0",1570040,CDM,278,RC,,,OUTPATIENT,,,7495,5996,,6370.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1873.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1873.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1873.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1526.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3910.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3910.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3910.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3910.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6745.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2623.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",5149.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6745.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4347.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1526.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6370.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1526.73,6745.5,
"IMPLANT METAL HEMIARTHROPLASTY",1570042,CDM,278,RC,L8641,HCPCS,OUTPATIENT,,,4480,3584,,3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2337.26,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2337.26,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2337.26,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2337.26,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",1568,35,,,,,0,"percent of total billed charges","35% of total billed charges",3077.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",2598.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,4032,
"IMPLANT SYSTEM BIOCOMP 2.9MM P-LCK SHORT",1570865,CDM,278,RC,,,OUTPATIENT,,,3270,2616,,2779.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",817.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",817.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",817.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",666.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1705.99,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1705.99,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1705.99,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1705.99,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2943,90,,,,,0,"percent of total billed charges","90% of total billed charges",1144.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2246.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2943,90,,,,,0,"percent of total billed charges","90% of total billed charges",1896.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",666.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2779.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",666.1,2943,
"IMPLANT SYSTEM SPEEDBRG W/BIO-COMP",1570853,CDM,278,RC,,,OUTPATIENT,,,17847,14277.6,,15169.95,85,,,,,0,"percent of total billed charges","85% of total billed charges",4461.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4461.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4461.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3635.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9310.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",9310.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",9310.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",9310.96,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",16062.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",6246.45,35,,,,,0,"percent of total billed charges","35% of total billed charges",12260.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",16062.3,90,,,,,0,"percent of total billed charges","90% of total billed charges",10351.26,58,,,,,0,"percent of total billed charges","58% of total billed charges",3635.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15169.95,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3635.43,16062.3,
"IMPLANTABLE TISSUE MARKER",1544648,CDM,278,RC,A4648,HCPCS,OUTPATIENT,,,850,680,,722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",765,90,,,,,0,"percent of total billed charges","90% of total billed charges",297.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",583.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",765,90,,,,,0,"percent of total billed charges","90% of total billed charges",493,58,,,,,0,"percent of total billed charges","58% of total billed charges",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,765,
"IMPLANTABLE TISSUE MARKER",1546481,CDM,278,RC,A4648,HCPCS,OUTPATIENT,,,975,780,,828.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",198.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",877.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",341.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",669.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",877.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",565.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",198.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",828.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,877.5,
K-WIRE,1570354,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"K-WIRE 0.9MM",1570356,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"K-WIRE 1.1 TROCAR 100MM",1570357,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"K-WIRE 1.3 FOR 4.0 CANNULATED SCREW",1570353,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"K-WIRE 1.4mm",1570045,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"K-WIRE 1.6mm",1570352,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"K-WIRE KM172-26-45 .045",7905723,CDM,278,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"K-WIRE KM172-26-62",1570032,CDM,278,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MARLEX MESH 1 X 4",7905866,CDM,278,RC,,,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",186.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,670.5,
"MARLEX MESH 1.8 X 4",7905794,CDM,278,RC,,,OUTPATIENT,,,1355,1084,,1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",706.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",706.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",706.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",706.92,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",474.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",930.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",785.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,1219.5,
"MARLEX MESH 3 X 6",7905867,CDM,278,RC,,,OUTPATIENT,,,1025,820,,871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",358.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",704.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",594.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,922.5,
"MESH 3D MAX R/L",7950129,CDM,278,RC,,,OUTPATIENT,,,865,692,,735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",302.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",594.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",501.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,778.5,
"NAIL FIBULOCK 3.0X130 MM, LEFT",1570836,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,13477.5,10782,,11455.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",3369.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",3369.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",3369.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2745.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7031.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7031.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7031.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7031.35,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",12129.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",4717.13,35,,,,,0,"percent of total billed charges","35% of total billed charges",9259.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12129.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",7816.95,58,,,,,0,"percent of total billed charges","58% of total billed charges",2745.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11455.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2745.37,12129.75,
"NAIL FIBULOCK 3.8X130MM LEFT",1570878,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,15741.72,12593.38,,13380.46,85,,,,,0,"percent of total billed charges","85% of total billed charges",3935.43,25,,,,,0,"percent of total billed charges","25% of total billed charges",3935.43,25,,,,,0,"percent of total billed charges","25% of total billed charges",3935.43,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3206.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8212.61,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8212.61,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8212.61,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",8212.61,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",14167.55,90,,,,,0,"percent of total billed charges","90% of total billed charges",5509.6,35,,,,,0,"percent of total billed charges","35% of total billed charges",10814.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14167.55,90,,,,,0,"percent of total billed charges","90% of total billed charges",9130.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3206.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13380.46,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3206.59,14167.55,
"NEEDLE SCLEROTHERAPY",7950187,CDM,278,RC,,,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,274.5,
"NEEDLE SCLEROTHERAPY M00518361",7950188,CDM,278,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"OSTEOSET MINI BEADS",1570065,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,3205,2564,,2724.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",801.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",801.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",801.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",652.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1672.08,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1672.08,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1672.08,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1672.08,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2884.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1121.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2201.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2884.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1858.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",652.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2724.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",652.86,2884.5,
"PLATE DISTAL RADIUS 2.4 TI 2CLM 6H HD 2H",1570069,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,9564,7651.2,,8129.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",2391,25,,,,,0,"percent of total billed charges","25% of total billed charges",2391,25,,,,,0,"percent of total billed charges","25% of total billed charges",2391,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1948.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4989.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4989.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4989.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",4989.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",8607.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",3347.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",6570.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8607.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",5547.12,58,,,,,0,"percent of total billed charges","58% of total billed charges",1948.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8129.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1948.19,8607.6,
"PLATE LOCKING STRAIGHT SS 12H",1570898,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1729.47,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1729.47,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1729.47,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1729.47,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,2983.5,
"PLATE VLP 2.7MM MTP",1570360,CDM,278,RC,A4649,HCPCS,OUTPATIENT,,,3135,2508,,2664.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",783.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",783.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",783.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",638.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1635.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1635.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1635.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1635.56,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2821.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1097.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2153.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2821.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1818.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",638.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2664.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",638.6,2821.5,
"PORT DIGNITY MINI",7905981,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,1250,1000,,1062.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",254.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",652.14,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",652.14,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",652.14,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",652.14,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125,90,,,,,0,"percent of total billed charges","90% of total billed charges",437.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",858.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125,90,,,,,0,"percent of total billed charges","90% of total billed charges",725,58,,,,,0,"percent of total billed charges","58% of total billed charges",254.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1062.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",254.63,1125,
"PORT INDWELLING IMPLANTABLE",1501788,CDM,278,RC,C1788,HCPCS,OUTPATIENT,,,1400,1120,,1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",350,25,,,,,0,"percent of total billed charges","25% of total billed charges",350,25,,,,,0,"percent of total billed charges","25% of total billed charges",350,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",285.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",730.39,52.17,,60.92,60.92,60.92,"1 through 10","percent of total billed charges","52.17% of total billed charges",730.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",730.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",730.39,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1260,90,,,,,0,"percent of total billed charges","90% of total billed charges",490,35,,,,,0,"percent of total billed charges","35% of total billed charges",961.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1260,90,,,,,0,"percent of total billed charges","90% of total billed charges",812,58,,,,,0,"percent of total billed charges","58% of total billed charges",285.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",285.18,1260,
"PORT-A-CATH 21-4000-24",7905965,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,1130,904,,960.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",282.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",282.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",230.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1017,90,,,,,0,"percent of total billed charges","90% of total billed charges",395.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",776.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1017,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",230.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",960.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,1017,
"POWER PORT GUIDEWIRE",7905962,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"POWERLOC HUBER INFUSION SET 20 G X 1 IN",7905970,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POWERLOC HUBER INFUSION SET 20GX1.5IN",7905972,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"POWERLOC HUBER INFUSION SET 22 G X 1 IN",7905982,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"POWERPICC CATHETER 5FR SL",7905968,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",86.57,382.5,
"POWERPORT IMPLANT PORT 1808000 NEW 2025",7905978,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"POWERPORT IMPLANTABLE PORT 1708000",7905967,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"POWERPORT IMPLANTABLE PORT 1708001",7905969,CDM,278,RC,C1751,HCPCS,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"POWERPORT IMPLANTABLE PORT 1808000",7905977,CDM,278,RC,C1788,HCPCS,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",335,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",699.09,52.17,,60.92,60.92,60.92,"1 through 10","percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",699.09,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",272.96,1206,
"REAMER 4.0 MM STERILE",1570876,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,800,640,,680,85,,,,,0,"percent of total billed charges","85% of total billed charges",200,25,,,,,0,"percent of total billed charges","25% of total billed charges",200,25,,,,,0,"percent of total billed charges","25% of total billed charges",200,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",162.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",720,90,,,,,0,"percent of total billed charges","90% of total billed charges",280,35,,,,,0,"percent of total billed charges","35% of total billed charges",549.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",720,90,,,,,0,"percent of total billed charges","90% of total billed charges",464,58,,,,,0,"percent of total billed charges","58% of total billed charges",162.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",680,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,720,
"REPAIR KIT DISPOS FIBERTAK RC",1570349,CDM,278,RC,,,OUTPATIENT,,,905,724,,769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",621.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",524.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,814.5,
"REPAIR KIT GLUTEUS MEDIUS TENDON",1570348,CDM,278,RC,,,OUTPATIENT,,,5890,4712,,5006.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1199.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3072.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3072.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3072.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3072.87,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",5301,90,,,,,0,"percent of total billed charges","90% of total billed charges",2061.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4046.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5301,90,,,,,0,"percent of total billed charges","90% of total billed charges",3416.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1199.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5006.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1199.79,5301,
"REPAIR KIT TIGHTROPE SYNDESMOSIS",1570171,CDM,278,RC,,,OUTPATIENT,,,3055,2444,,2596.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",763.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",763.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",763.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",622.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1593.82,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1593.82,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1593.82,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1593.82,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2749.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1069.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2098.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2749.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1771.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",622.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2596.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",622.3,2749.5,
"SCREW 2.0MM X 9MM CANNULATED",1570068,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,684,
"SCREW 2.4 TI CORTEX SCR T8 REC 14",1570128,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,600,480,,510,85,,,,,0,"percent of total billed charges","85% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",210,35,,,,,0,"percent of total billed charges","35% of total billed charges",412.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",348,58,,,,,0,"percent of total billed charges","58% of total billed charges",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",510,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,540,
"SCREW 2.4 TI CORTEX SCR T8 REC 16",1570129,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,600,480,,510,85,,,,,0,"percent of total billed charges","85% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",210,35,,,,,0,"percent of total billed charges","35% of total billed charges",412.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",348,58,,,,,0,"percent of total billed charges","58% of total billed charges",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",510,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,540,
"SCREW 25MM 3.0 CANNULATED",1570079,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1575,1260,,1338.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",393.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",393.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",393.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",320.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",821.69,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",821.69,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",821.69,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",821.69,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1417.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",551.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1082.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1417.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",913.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",320.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1338.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",320.83,1417.5,
"SCREW 26MM 4.0 CANNULATED",1570071,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,684,
"SCREW 34MM 4.0 CANNULATED",1570070,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,684,
"SCREW 4.0 LOCKING OSTEOPENIA 10MM",1570036,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,751.5,
"SCREW 4.0 LOCKING OSTEOPENIA 12MM",1570037,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,751.5,
"SCREW 4.0 LOCKING OSTEOPENIA 14MM",1570038,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,751.5,
"SCREW 4.0 LOCKING OSTEOPENIA 16MM",1570039,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,751.5,
"SCREW BONE 2.0 X 14MM CHARLOTTE SNAP-OFF",1570030,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1105,884,,939.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",276.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",276.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",276.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",225.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",994.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",386.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",759.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",994.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",640.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",225.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",939.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,994.5,
"SCREW BONE 2.0 X 14MM SNAP-OFF",1570640,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,801,
"SCREW BONE 2.7 X 13MM CHARLOTTE SNAP-OFF",1570033,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1435,1148,,1219.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",358.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",358.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",358.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1291.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",502.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",985.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1291.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",832.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",292.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1219.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.31,1291.5,
"SCREW BONE 2.7 X 15MM CHARLOTTE SNAP-OFF",1570034,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1435,1148,,1219.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",358.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",358.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",358.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",748.65,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1291.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",502.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",985.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1291.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",832.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",292.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1219.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.31,1291.5,
"SCREW BONE 3.5MM LOCKING SELF TAP 12MM",1570020,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,535.5,
"SCREW BONE 3.5MM LOCKING SELF TAP 14MM",1570021,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,535.5,
"SCREW BONE 3.5MM LOCKING SELF TAP 16MM",1570022,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,535.5,
"SCREW BONE 3.5MM LOCKING SELF TAP 20MM",1570023,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,535.5,
"SCREW BONE 3.5MM LOCKING SELF TAP 45MM",1570024,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"SCREW LO-PRO SS 4.0 X 12MM CANCELLOUS",1570893,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"SCREW LO-PRO SS 4.0 X 14MM CANCELLOUS",1570894,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"SCREW LO-PRO TM SS 2.7 X 16MM CORT",1570890,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"SCREW LO-PRO TM SS 3.5 X 12MM CORT",1570891,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"SCREW LO-PRO TM SS 3.5 X 50MM CORT",1570892,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",41.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.61,148.5,
"SCREW QWIX FIXATION 3.0MM X 26MM",1570078,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1585,1268,,1347.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",396.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",396.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",396.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",322.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1426.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",554.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1088.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1426.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",919.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",322.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1347.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",322.86,1426.5,
"SCREW SPIN 2MM DIA--12MM LENGTH",1570076,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1505,1204,,1279.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",376.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",376.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",376.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",306.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1354.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",526.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1033.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1354.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",872.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",306.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1279.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",306.57,1354.5,
"SCREW SPIN 2MM DIA--13MM LENGTH",1570074,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1505,1204,,1279.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",376.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",376.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",376.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",306.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",785.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1354.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",526.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1033.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1354.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",872.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",306.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1279.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",306.57,1354.5,
"SCREW SPIN 2MM DIA--14MM LENGTH",1570075,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1585,1268,,1347.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",396.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",396.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",396.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",322.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",826.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1426.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",554.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1088.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1426.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",919.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",322.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1347.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",322.86,1426.5,
"SCREW VA LOCKING STARDRIVE 2.4MM 14MM",1570072,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1415,1132,,1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",495.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",972.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",820.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",288.24,1273.5,
"SCREW VA LOCKING STARDRIVE 2.4MM 18MM",1570073,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1415,1132,,1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",495.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",972.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",820.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",288.24,1273.5,
"SCREW VA LOCKING STARDRIVE 2.4MM 22MM",1570127,CDM,278,RC,C1713,HCPCS,OUTPATIENT,,,1415,1132,,1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",353.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",738.22,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",495.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",972.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",820.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",288.24,1273.5,
"SCREWS LAG ALL/SIZES",7901055,CDM,278,RC,,,OUTPATIENT,,,1120,896,,952,85,,,,,0,"percent of total billed charges","85% of total billed charges",280,25,,,,,0,"percent of total billed charges","25% of total billed charges",280,25,,,,,0,"percent of total billed charges","25% of total billed charges",280,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",228.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1008,90,,,,,0,"percent of total billed charges","90% of total billed charges",392,35,,,,,0,"percent of total billed charges","35% of total billed charges",769.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1008,90,,,,,0,"percent of total billed charges","90% of total billed charges",649.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",228.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",952,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,1008,
"SIZER IMPLANT BREAST 351-2800SZ",1571408,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"SIZER IMPLANT BREAST 351-3630SZ",1571415,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"SIZER IMPLANT BREAST GEL SZUHE1030",1571409,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,3600,2880,,3060,85,,,,,0,"percent of total billed charges","85% of total billed charges",900,25,,,,,0,"percent of total billed charges","25% of total billed charges",900,25,,,,,0,"percent of total billed charges","25% of total billed charges",900,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.32,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1878.16,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",1878.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1878.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1878.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",3240,90,,,,,0,"percent of total billed charges","90% of total billed charges",1260,35,,,,,0,"percent of total billed charges","35% of total billed charges",2473.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3240,90,,,,,0,"percent of total billed charges","90% of total billed charges",2088,58,,,,,0,"percent of total billed charges","58% of total billed charges",733.32,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3060,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.32,3240,
"SIZER IMPLANT BREAST GEL SZUHE1240",1571410,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,3600,2880,,3060,85,,,,,0,"percent of total billed charges","85% of total billed charges",900,25,,,,,0,"percent of total billed charges","25% of total billed charges",900,25,,,,,0,"percent of total billed charges","25% of total billed charges",900,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.32,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1878.16,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",1878.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1878.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1878.16,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",3240,90,,,,,0,"percent of total billed charges","90% of total billed charges",1260,35,,,,,0,"percent of total billed charges","35% of total billed charges",2473.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3240,90,,,,,0,"percent of total billed charges","90% of total billed charges",2088,58,,,,,0,"percent of total billed charges","58% of total billed charges",733.32,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3060,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.32,3240,
"SIZER IMPLANT BREAST RSZ-2001S",1571177,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-2251S",1571151,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-2501S",1571179,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-2504S",1571163,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-2751S",1571180,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3001S",1571181,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3004S",1571164,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3251S",1571182,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3254S",1571188,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3501S",1571183,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3504S",1571165,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3751S",1571184,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-3754S",1571189,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4001S",1571185,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4004S",1571166,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4251S",1571186,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4254S",1571190,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4501S",1571187,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4504S",1571098,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-4754S",1571191,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5004S",1571099,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5350S",1571097,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5375S",1571101,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5400S",1571093,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5430S",1571102,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5430S",1571192,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5455S",1571078,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5455S",1571094,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5480S",1571066,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5504S",1571063,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5535S",1571079,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5535S",1571095,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5590S",1571067,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5650S",1571050,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5650S",1571096,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5700S",1571077,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5750S",1571092,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-5800S",1571042,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-6004S",1571100,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-6504S",1571064,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7004S",1571167,CDM,278,RC,,,OUTPATIENT,,,2040,1632,,1734,85,,,,,0,"percent of total billed charges","85% of total billed charges",510,25,,,,,0,"percent of total billed charges","25% of total billed charges",510,25,,,,,0,"percent of total billed charges","25% of total billed charges",510,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",415.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1836,90,,,,,0,"percent of total billed charges","90% of total billed charges",714,35,,,,,0,"percent of total billed charges","35% of total billed charges",1401.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1836,90,,,,,0,"percent of total billed charges","90% of total billed charges",1183.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",415.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1734,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",415.55,1836,
"SIZER IMPLANT BREAST RSZ-7215MCS",1571152,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7235MCS",1571153,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7255MCS",1571154,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7275MCS",1571155,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7300MCS",1571156,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7320MCS",1571157,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7340MCS",1571158,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7360MCS",1571146,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7385MCS",1571159,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7405MCS",1571160,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7425MCS",1571161,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7445MCS",1571162,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7504S",1571043,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-7504S",1571065,CDM,278,RC,,,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",460,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",959.95,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,,,,0,"percent of total billed charges","35% of total billed charges",1264.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",374.81,1656,
"SIZER IMPLANT BREAST RSZ-8004S",1571168,CDM,278,RC,,,OUTPATIENT,,,2040,1632,,1734,85,,,,,0,"percent of total billed charges","85% of total billed charges",510,25,,,,,0,"percent of total billed charges","25% of total billed charges",510,25,,,,,0,"percent of total billed charges","25% of total billed charges",510,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",415.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1064.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1836,90,,,,,0,"percent of total billed charges","90% of total billed charges",714,35,,,,,0,"percent of total billed charges","35% of total billed charges",1401.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1836,90,,,,,0,"percent of total billed charges","90% of total billed charges",1183.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",415.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1734,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",415.55,1836,
"SIZER IMPLANT BREAST RSZHPB325S",1570974,CDM,278,RC,,,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZHPB370S",1571068,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB405S",1570976,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB440S",1571070,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB480S",1570979,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZHPB520S",1571072,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB545S",1570980,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB585S",1570981,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB635S",1570982,CDM,278,RC,,,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB685S",1571073,CDM,278,RC,,,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZHPB740S",1571074,CDM,278,RC,,,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZHPB775S",1570985,CDM,278,RC,,,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZMPB210S",1570960,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB235S",1570962,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB265S",1570961,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB290S",1570963,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB320S",1570967,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB340S",1570983,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZMPB390S",1570969,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB430S",1570984,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZMPB450S",1571400,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB480S",1570949,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB530S",1571402,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,965,772,,820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",241.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",337.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",662.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",868.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",559.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",196.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",820.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,868.5,
"SIZER IMPLANT BREAST RSZMPB545S",1571405,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB590S",1571403,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB630S",1571406,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB675S",1571404,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZMPB730S",1571407,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1872,1497.6,,1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",468,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",976.64,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",976.64,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",655.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1286.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1684.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1085.76,58,,,,,0,"percent of total billed charges","58% of total billed charges",381.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1591.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",381.33,1684.8,
"SIZER IMPLANT BREAST RSZ-MPX-215S",1571104,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-MPX-240S",1571105,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-MPX-240S",1571147,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-MPX-270S",1571106,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-MPX-295S",1571107,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-MPX-325S",1571108,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-MPX-350S",1571109,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-MPX-350S",1571113,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-MPX-370S",1571110,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-MPX-405S",1571111,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-MPX-440S",1571112,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-260S",1570965,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-335S",1570966,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,8731.75,5068.99,12394.51,"1 through 10",other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-355S",1570958,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-380S",1570968,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-415S",1570959,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-450S",1570970,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-465S",1570971,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-490S",1570972,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-535S",1570973,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-560S",1570957,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-560S",1570987,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-595S",1570975,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-650S",1570989,CDM,278,RC,C1789,HCPCS,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,8731.75,5068.99,12394.51,"1 through 10","percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-700S",1570977,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SHPX-755S",1571024,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SHPX-790S",1570978,CDM,278,RC,,,OUTPATIENT,,,1960,1568,,1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",686,35,,,,,0,"percent of total billed charges","35% of total billed charges",1346.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",1136.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,1764,
"SIZER IMPLANT BREAST RSZ-SMHX-230S",1570954,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-255S",1570948,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-280S",1570955,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-310S",1570947,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-330S",1570956,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-350S",1570986,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SMHX-375S",1570964,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-400S",1570988,CDM,278,RC,,,OUTPATIENT,,,925,740,,786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",231.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",323.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",635.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",832.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",536.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",786.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,832.5,
"SIZER IMPLANT BREAST RSZ-SMHX-430S",1571103,CDM,278,RC,,,OUTPATIENT,,,1960,1568,,1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",490,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1022.55,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",686,35,,,,,0,"percent of total billed charges","35% of total billed charges",1346.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1764,90,,,,,0,"percent of total billed charges","90% of total billed charges",1136.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",399.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1666,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",399.25,1764,
"SIZER IMPLANT BREAST RSZ-SMHX-470S",1571027,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-545S",1571028,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-580S",1571025,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-630S",1571061,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SIZER IMPLANT BREAST RSZ-SMHX-700S",1571026,CDM,278,RC,,,OUTPATIENT,,,1792,1433.6,,1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",448,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",934.9,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",627.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1231.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1612.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",1039.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1523.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.03,1612.8,
"SURGIPRO MESH",7905207,CDM,278,RC,,,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,301.5,
"SURGIPRO MESH 1 X 4",7950215,CDM,278,RC,,,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,,,,0,"percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,288,
"TISSUE EXPANDER FILL KIT",1570830,CDM,278,RC,,,OUTPATIENT,,,110,88,,93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",75.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,99,
".ALPHA-1 ANTITRYPSIN PHENO",3082104,CDM,300,RC,82104,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.75,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,279,
".ANTIGLOBULIN (X-M)",3086922,CDM,300,RC,86922,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",31.57,20.37,,24.46,24.46,24.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",31.57,202.43,
".B2 IGA",3000657,CDM,300,RC,86146,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,117,
".B2 IGG",3000655,CDM,300,RC,86146,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,117,
".B2 IGM",3000656,CDM,300,RC,86146,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,117,
".BABESIOSIS IgG ANTIBODIES",3000026,CDM,300,RC,86753,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,225,
".BABESIOSIS IgM ANTIBODIES",3000028,CDM,300,RC,86753,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,225,
".BACTERIUM ANTIBODIES NES",3006609,CDM,300,RC,86609,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,12.62,12.62,12.62,"1 through 10","fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,297,
".C DIFF ANTIGEN",3000685,CDM,300,RC,87449,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,7.55,7.19,7.90,"1 through 10","percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,135,
".C DIFF TOXINS A/B",3000684,CDM,300,RC,87324,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,5.04,4.80,5.27,"1 through 10","percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,58.50,58.50,58.50,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,135,
".CELL COUNT CSF",3000719,CDM,300,RC,89050,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,126,
".CHLAMYDIA URINE",3087491,CDM,300,RC,87491,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,28.15,28.15,28.15,"1 through 10","fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,351,
".CYCLOSPORA CONCENTRATION",3000076,CDM,300,RC,87015,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,139.5,
".CYCLOSPORA STAIN",3087207,CDM,300,RC,87207,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,139.5,
".DENSITY GRADIENT SEPARATION",3086972,CDM,300,RC,86972,HCPCS,OUTPATIENT,,,865,692,,735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",486.13,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",486.13,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",302.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",594.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",501.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,778.5,
".DONATH-LANDSTEINER Ab",3086941,CDM,300,RC,86941,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,351,
".FLOW CYTOMETRY, EA MARKER",3000113,CDM,300,RC,88182,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",80.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",83.82,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",80.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,139.5,
".GC URINE",3087591,CDM,300,RC,87591,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.78,351,
".IMMEDIATE SPIN (X-M)",3086920,CDM,300,RC,86920,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",56.02,20.37,,43.39,43.39,43.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",56.02,247.5,
".IMMUNOASSAY NOT SPECIFIED",3000163,CDM,300,RC,83520,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,72,
".INCUBATION (X-M)",3086921,CDM,300,RC,86921,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",45.83,20.37,,35.50,35.50,35.50,"1 through 10","percent of total billed charges","20.37% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",45.83,202.5,
".INFLUENZA A RAPID TEST",3087400,CDM,300,RC,87400,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.37,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,13.92,11.29,16.55,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,4.74,4.26,4.74,"1 through 10","percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.41,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,14.13,14.13,14.13,"1 through 10","fee schedule","125.18% of GA fee schedule",96.18,68.7,,54.60,54.60,54.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.72,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,14.13,14.13,14.13,"1 through 10","fee schedule","120.37% of GA fee schedule",14.13,100,,13.85,13.85,13.85,"1 through 10","fee schedule","100% of CMS fee schedule",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.72,126,
".INFLUENZA B RAPID TEST",3000172,CDM,300,RC,87400,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.37,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,13.92,11.29,16.55,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,4.74,4.26,4.74,"1 through 10","percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.41,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,14.13,14.13,14.13,"1 through 10","fee schedule","125.18% of GA fee schedule",96.18,68.7,,54.60,54.60,54.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.72,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,14.13,14.13,14.13,"1 through 10","fee schedule","120.37% of GA fee schedule",14.13,100,,13.85,13.85,13.85,"1 through 10","fee schedule","100% of CMS fee schedule",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.72,126,
".LIPOPROTEIN BKDWN;HI RESO",3083701,CDM,300,RC,83701,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",37.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",34.54,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.47,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.47,207,
".PROTEIN, WESTERN BLOT",3084181,CDM,300,RC,84181,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.37,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.33,162,
".RICKETTSIAL IgG",3000262,CDM,300,RC,86255,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,117,
"3RD ACR BINDING AUTOANTIBODY",3000600,CDM,300,RC,83519,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,117,
"3RD CALPROTECTIN STOOL",3000900,CDM,300,RC,83993,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.02,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.89,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.67,117,
"3RD EHRLICHIA ANTIBODIES",3000096,CDM,300,RC,86666,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,148.5,
"3RD FACTOR VIII",3000812,CDM,300,RC,85240,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,126,
"3RD HEPATITIS C GENOTYPE",3000146,CDM,300,RC,87902,HCPCS,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",132.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",528.28,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",528.28,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",262.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",137.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",231.71,90,,,,,0,"fee schedule","90% of CMS fee schedule",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",132.01,846,
"3RD HERPES SIMPLEX VIRUS,QUAN",3087530,CDM,300,RC,87530,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",175,35,,,,,0,"percent of total billed charges","35% of total billed charges",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,450,
"3RD HIV GENOTYPE",3000151,CDM,300,RC,87901,HCPCS,OUTPATIENT,,,1405,1124,,1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",132.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",789.61,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",793.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",789.61,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",793.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",262.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",1264.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",137.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",965.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",231.71,90,,,,,0,"fee schedule","90% of CMS fee schedule",814.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",1194.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",257.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",132.01,1264.5,
"3RD LYME DISEASE",3086618,CDM,300,RC,86617,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.39,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,243,
"3RD RAPAMYCIN/SIROLIMUS",3000250,CDM,300,RC,80195,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14,102,,,,,0,"fee schedule","102% of CMS fee schedule",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.36,90,,,,,0,"fee schedule","90% of CMS fee schedule",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.36,526.5,
"3RD RETICULIN IgA AB",3086256,CDM,300,RC,86255,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,297,
"3RD STREP PNEUMOCOCCAL 14 PANEL",3086609,CDM,300,RC,86609,HCPCS,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,12.62,12.62,12.62,"1 through 10","fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,549,
"3RD TPMT GENOTYPE",3000635,CDM,300,RC,81401,HCPCS,OUTPATIENT,,,2050,1640,,1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",178.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",134.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1152.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1152.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",139.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",1845,90,,,,,0,"percent of total billed charges","90% of total billed charges",140.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1408.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",1189,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.3,1845,
"3RD TSH RECEPTOR ANTIBODY",3084445,CDM,300,RC,84445,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",51.88,102,,,,,0,"fee schedule","102% of CMS fee schedule",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.33,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.82,369,
"3RD WBC COUNT STOOL/LACTOFERRIN",3089055,CDM,300,RC,83630,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.61,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.09,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.19,103.5,
"ALPHA-FETOPROTEIN BODY FLUID",3000607,CDM,300,RC,82106,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.34,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,207,
"ANTI FACTOR XA (LOVENOX)",3085520,CDM,300,RC,85520,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.6,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.78,369,
"AUTOANTIBODIES TOTAL",3000601,CDM,300,RC,86255,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,117,
"BB ABO TYPE",3000380,CDM,300,RC,86900,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",4.51,120.37,,4.29,4.29,4.29,"1 through 10","fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.69,125.18,,2.99,2.99,2.99,"1 through 10","fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.51,120.37,,2.99,2.99,2.99,"1 through 10","fee schedule","120.37% of GA fee schedule",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4.51,152.27,
"BB ANTIBODY SCREEN",3086850,CDM,300,RC,86850,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",18.33,120.37,,17.37,17.37,17.37,"1 through 10","fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,120.37,,15.23,15.23,15.23,"1 through 10","fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",18.33,207,
"BB BLOOD TYPE, ABO",3086900,CDM,300,RC,86900,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",4.51,120.37,,4.29,4.29,4.29,"1 through 10","fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.69,125.18,,2.99,2.99,2.99,"1 through 10","fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.51,120.37,,2.99,2.99,2.99,"1 through 10","fee schedule","120.37% of GA fee schedule",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4.51,152.27,
"BB RH BLOOD TYPE",3086901,CDM,300,RC,86901,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",17.47,120.37,,16.56,16.56,16.56,"1 through 10","fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.16,125.18,,2.99,2.99,2.99,"1 through 10","fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.47,120.37,,2.99,2.99,2.99,"1 through 10","fee schedule","120.37% of GA fee schedule",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.47,81,
"BLOOD TYPE ANTIGEN DONOR",3086902,CDM,300,RC,86902,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",5.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",421.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",421.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.18,675,
"BONE MARROW PATH HANDLING",3000032,CDM,300,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"BOTULINUM TOXIN A AB",3000033,CDM,300,RC,84182,HCPCS,OUTPATIENT,,,1180,944,,1003,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",663.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",29.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",1062,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",810.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",684.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1003,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.29,1062,
"C2 COMPLEMENT",3000609,CDM,300,RC,86160,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,346.5,
"CANDIDA ANTIBODIES",3086628,CDM,300,RC,86628,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.61,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.25,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,126,
"CARNITINE,SERUM",3082379,CDM,300,RC,82379,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.55,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.18,387,
"CBC W DIFF",3099005,CDM,300,RC,85025,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.76,120.37,,11.15,9.12,11.41,"1 through 10","fee schedule","120.37% of GA fee schedule",154.55,56.2,,4.60,4.31,5.75,11,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.93,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.23,125.18,,7.77,7.77,7.77,"1 through 10","fee schedule","125.18% of GA fee schedule",188.93,68.7,,107.25,107.25,107.25,"1 through 10","percent of total billed charges","68.7% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.99,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.76,120.37,,7.77,7.77,7.77,32,"fee schedule","120.37% of GA fee schedule",7.77,100,,7.61,7.61,7.61,75,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.99,247.5,
"CBC W DIFF AND RETIC",3000742,CDM,300,RC,85025,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.76,120.37,,11.15,9.12,11.41,"1 through 10","fee schedule","120.37% of GA fee schedule",154.55,56.2,,4.60,4.31,5.75,11,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.93,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.23,125.18,,7.77,7.77,7.77,"1 through 10","fee schedule","125.18% of GA fee schedule",188.93,68.7,,107.25,107.25,107.25,"1 through 10","percent of total billed charges","68.7% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.99,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.76,120.37,,7.77,7.77,7.77,32,"fee schedule","120.37% of GA fee schedule",7.77,100,,7.61,7.61,7.61,75,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.99,247.5,
"CD 19/CD 3",3088184,CDM,300,RC,88184,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",55.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",55.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",55.49,424.95,
CD3/C19,3086359,CDM,300,RC,86359,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",35.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",38.48,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.96,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.96,297,
"CELL COUNT CSF",3000042,CDM,300,RC,89050,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,126,
"CHLAMYDIA/ SWAB/URINE",3000550,CDM,300,RC,87491,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,28.15,28.15,28.15,"1 through 10","fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,207,
"CO2 URINE 24 HOUR",3000058,CDM,300,RC,82374,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.34,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,342,
"COLLJ CAPILLARY BLOOD SPEC",2036416,CDM,300,RC,36416,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"COLLJ CAPILLARY BLOOD SPEC",3036416,CDM,300,RC,36416,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"COOMBS, DIRECT (CRD)",3086880,CDM,300,RC,86880,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.12,166.5,
"CoV-2 SARS ANTIGEN SWAB",3087426,CDM,300,RC,87426,HCPCS,OUTPATIENT,,,260,208,,221,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",43.55,120.37,,32.99,27.00,38.98,"1 through 10","fee schedule","120.37% of GA fee schedule",146.12,56.2,,34.97,18.40,34.97,"1 through 10","percent of total billed charges","56.20% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.29,125.18,,35.33,35.33,35.33,"1 through 10","fee schedule","125.18% of GA fee schedule",178.62,68.7,,101.40,101.40,101.40,"1 through 10","percent of total billed charges","68.7% of total billed charges",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",150.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",43.55,120.37,,35.33,35.33,35.33,"1 through 10","fee schedule","120.37% of GA fee schedule",35.33,100,,34.62,34.62,34.62,"1 through 10","fee schedule","100% of CMS fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",221,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.8,234,
"COVID-19 RAPID IgM  IgG",3086328,CDM,300,RC,86328,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",61.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",46.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",45.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,184.5,
"COVID-19 SWAB",300800,CDM,300,RC,87635,HCPCS,OUTPATIENT,,,260,208,,221,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",61.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",146.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",146.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",146.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",52.34,102,,,,,0,"fee schedule","102% of CMS fee schedule",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",178.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",150.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",221,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.18,234,
"CRIDER INTERVENT SCREEN",3000077,CDM,300,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CULTURE CSF",3087070,CDM,300,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE STOOL BY PCR",3000970,CDM,300,RC,87507,HCPCS,OUTPATIENT,,,1560,1248,,1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",541.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",401.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",876.72,56.2,,174.95,166.72,183.18,"1 through 10","percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",425.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",1404,90,,,,,0,"percent of total billed charges","90% of total billed charges",417.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1071.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",375.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",904.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",401.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",416.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",375.1,1404,
"CYCLIC CITRULLINATED PEPTIDE",3086200,CDM,300,RC,86200,HCPCS,OUTPATIENT,,,490,392,,416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.84,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",441,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",336.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",284.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.95,100,,12.69,12.69,12.69,"1 through 10","fee schedule","100% of CMS fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.66,441,
CYTOLOGY/HANDLING,3000107,CDM,300,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"D2 DUST MITE",3000604,CDM,300,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"DENGUE VIRUS IgG ANTIBODY",3086790,CDM,300,RC,86790,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,418.5,
"DENGUE VIRUS IgM ANTIBODY",3000083,CDM,300,RC,86790,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,418.5,
"DRUG SCREEN, HANDLING",3099001,CDM,300,RC,80377,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"ENTEROVIRUS PCR",3087798,CDM,300,RC,87498,HCPCS,OUTPATIENT,,,1180,944,,1003,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",663.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",1062,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",810.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",684.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",1003,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,1062,
"EOSIN COUNT URINE",3000101,CDM,300,RC,85999,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"FACTOR V LEIDEN",3000110,CDM,300,RC,81241,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.38,130,,,,,0,"fee schedule","130% of CMS fee schedule",48.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",74.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",48.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.15,279,
"FETAL FIBRONECTIN",3082731,CDM,300,RC,82731,HCPCS,OUTPATIENT,,,1560,1248,,1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",97.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",1404,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1071.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",904.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.97,1404,
"FROZEN SECTION PATH, HAND",3000115,CDM,300,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"GALACTOSE-1- PHOSPHATE RBC LEVEL",3082760,CDM,300,RC,84378,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,684,
"GC/ SWAB/URINE",3000551,CDM,300,RC,87591,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.78,207,
"H FLU b ANTIBODIES IgG",3086684,CDM,300,RC,86684,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.99,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.26,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.99,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.26,324,
"HEMOCULT 1-3 SPCMN",3082273,CDM,300,RC,82270,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.86,120.37,,4.61,4.61,4.61,"1 through 10","fee schedule","120.37% of GA fee schedule",56.2,56.2,,4.33,2.55,4.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.47,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.06,125.18,,4.38,4.38,4.38,"1 through 10","fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.38,100,,4.29,4.29,4.29,13,"fee schedule","100% of CMS fee schedule",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.94,90,
"HEP B SURFACE ANTIGEN",3087340,CDM,300,RC,87340,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.54,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.26,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.33,100,,10.12,10.12,10.12,"1 through 10","fee schedule","100% of CMS fee schedule",10.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,225,
"HEPATITIS BE ANTIGEN",3087350,CDM,300,RC,87350,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,225,
"HERPES SPINAL FLUID",3000150,CDM,300,RC,87530,HCPCS,OUTPATIENT,,,980,784,,833,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",550.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",550.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",882,90,,,,,0,"percent of total billed charges","90% of total billed charges",343,35,,,,,0,"percent of total billed charges","35% of total billed charges",673.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",568.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",833,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,882,
"HIV 1/2",3000152,CDM,300,RC,87389,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,23.83,23.83,23.83,"1 through 10","percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.56,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",24.08,100,,23.60,23.60,23.60,"1 through 10","fee schedule","100% of CMS fee schedule",24.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.67,94.5,
"HIV BY WESTERN BLOT",3086689,CDM,300,RC,86689,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.44,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,126,
"HIV DNA BY PRC",3087535,CDM,300,RC,87535,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,760.5,
"HTLV I/II",3000155,CDM,300,RC,86790,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,297,
"INDIRECT COOMBS",3086886,CDM,300,RC,86886,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.32,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.04,207,
"INTRINSIC FACTOR BLK AB",3086340,CDM,300,RC,86340,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,247.5,
"LEGIONELLA ANTIGEN FLUID/WASHING EIA",3000610,CDM,300,RC,87278,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.28,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.04,247.5,
"MANGANESE SERUM LEVEL",3083785,CDM,300,RC,83785,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",37.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.18,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.99,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.99,297,
"MATERNAL SCREEN 1",3082105,CDM,300,RC,82105,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,135,
"METABOLIC SCREEN",3000195,CDM,300,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"MOLECULAR DGN MUT BY TRAN",3083905,CDM,300,RC,83905,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.15,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.15,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"MOLECULAR DGN SEP",3083894,CDM,300,RC,83894,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"MOLECULE DIAG",3000361,CDM,300,RC,83892,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,684,
"MOLECULE ISOLATE NUCLEIC",3000330,CDM,300,RC,83891,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",190,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",154.81,684,
"MOLECULE NUCLEIC AMPLI",3000354,CDM,300,RC,81223,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",508.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",1201.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",427.12,1201.73,
"PAP SMEAR/HANDLING",3088142,CDM,300,RC,88142,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.34,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.67,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.67,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.23,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.67,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.23,94.5,
"PLAIN CBC",3085028,CDM,300,RC,85027,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.8,120.37,,9.29,9.29,9.29,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,4.79,4.79,4.79,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.8,120.37,,6.47,6.47,6.47,"1 through 10","fee schedule","120.37% of GA fee schedule",6.47,100,,6.34,6.34,6.34,25,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,180,
"PROTEIN BODY FLUID",3000242,CDM,300,RC,84157,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.6,126,
"PROTHROMBIN MUTATION",3000243,CDM,300,RC,81240,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.4,130,,,,,0,"fee schedule","130% of CMS fee schedule",48.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",67,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.12,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",48.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",65.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.15,279,
"PSA SCREENING",3000343,CDM,300,RC,G0103,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.31,100,,18.92,18.92,18.92,"1 through 10","fee schedule","100% of CMS fee schedule",19.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.38,387,
"RBC ANTIBODY TYPING",3000592,CDM,300,RC,86905,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",5.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.79,424.95,
"RC AB ID/EACH PANEL & MEDIA",3008687,CDM,300,RC,86870,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.37,424.95,
"RC AB ID/EACH SELECTED REAGENT CELL",3086885,CDM,300,RC,86885,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",8.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.65,202.43,
"RC AG SCREEN WITH PT SERUM PER UNIT",3086904,CDM,300,RC,86904,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",14.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.96,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",14.38,103.5,
"RC AGT PHASE CROSSMATCH",3008692,CDM,300,RC,86922,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",56.02,20.37,,24.46,24.46,24.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",56.02,247.5,
"RC ANTIBODY ELUTION REF LAB",3086860,CDM,300,RC,86860,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.37,202.43,
"RC ANTIBODY SCREEN REFERENCE LAB",3008685,CDM,300,RC,86850,HCPCS,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",18.33,120.37,,17.37,17.37,17.37,"1 through 10","fee schedule","120.37% of GA fee schedule",53.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,120.37,,15.23,15.23,15.23,"1 through 10","fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",18.33,85.5,
"RC ANTIBODY/EACH PANEL & MEDIA",3086870,CDM,300,RC,86870,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.37,424.95,
"RC DAT EACH ANTISERA (RC)",3008688,CDM,300,RC,86880,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.12,81,
"RC DIFFERENTIAL/AUTO ADS OF SERUM",3086978,CDM,300,RC,86978,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",26.48,117,
"RC PRETREATMENT OF RBC,INCUBATION",3086970,CDM,300,RC,86970,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.61,148.5,
"RC PRETREATMENT W/ENZYMES PER CELL (RC)",3086971,CDM,300,RC,86971,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.17,202.43,
"RC RBC ANTIGENS OTHER THAN ABO/RH(D) (RC",3086905,CDM,300,RC,86905,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",5.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",42.15,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.15,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.79,424.95,
"RC RH  TYPE",3008690,CDM,300,RC,86901,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",17.47,120.37,,16.56,16.56,16.56,"1 through 10","fee schedule","120.37% of GA fee schedule",42.15,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.15,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.16,125.18,,2.99,2.99,2.99,"1 through 10","fee schedule","125.18% of GA fee schedule",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.47,120.37,,2.99,2.99,2.99,"1 through 10","fee schedule","120.37% of GA fee schedule",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.47,67.5,
"RC RH PHENOTYPING COMPLETE",3086906,CDM,300,RC,86906,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",11.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11.74,139.5,
RH,3000379,CDM,300,RC,86901,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",17.47,120.37,,16.56,16.56,16.56,"1 through 10","fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.16,125.18,,2.99,2.99,2.99,"1 through 10","fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.47,120.37,,2.99,2.99,2.99,"1 through 10","fee schedule","120.37% of GA fee schedule",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.47,81,
"RIBOSOMAL P AB",3000698,CDM,300,RC,83516,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,139.5,
"SACCHAROMYCES CEREVIS IgA",3086671,CDM,300,RC,86671,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.3,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,342,
"SACCHAROMYCES CEREVIS IgG",3000277,CDM,300,RC,86671,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.3,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,342,
"TRICHOMONAS VAGINALIS SWAB/URINE",3087661,CDM,300,RC,87661,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.78,207,
"TRIGLYCERIDES BODY FLUID",3000606,CDM,300,RC,84478,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.46,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",165.79,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",165.79,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.17,265.5,
"TRYPTASE, SERUM",3000316,CDM,300,RC,83520,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,229.5,
URINALYSIS,3099006,CDM,300,RC,81003,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.41,120.37,,2.61,2.11,3.11,"1 through 10","fee schedule","120.37% of GA fee schedule",73.06,56.2,,1.33,1.23,1.66,"1 through 10","percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.54,125.18,,2.25,2.25,2.25,"1 through 10","fee schedule","125.18% of GA fee schedule",89.31,68.7,,50.70,50.70,50.70,"1 through 10","percent of total billed charges","68.7% of total billed charges",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.41,120.37,,2.25,2.25,2.25,17,"fee schedule","120.37% of GA fee schedule",2.25,100,,2.20,2.20,2.20,45,"fee schedule","100% of CMS fee schedule",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.03,117,
"VITAMIN K LEVEL",3000608,CDM,300,RC,84597,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.84,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.99,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.58,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.35,247.5,
"VON WILLEBRAND ANTIGEN",3000332,CDM,300,RC,85245,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",23.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,288,
.6-METHYLMERCAPTOPURINE,3000641,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,315,
.6-THIOGUANINE,3000642,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,315,
".ACID PHOS PROSTATIC",3084066,CDM,301,RC,84066,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.56,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.69,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.69,432,
".ALLERGEN (RAST PROFILE)",3086003,CDM,301,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
".B-12 (EFCH)",3000806,CDM,301,RC,82607,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,6.62,6.11,7.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.81,120.37,,15.08,15.08,15.08,"1 through 10","fee schedule","120.37% of GA fee schedule",15.08,100,,14.78,14.78,14.78,"1 through 10","fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,180,
".BACTERIUM AB",3000735,CDM,301,RC,86609,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,12.62,12.62,12.62,"1 through 10","fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,58.5,
".CREA CLR (24HR UA CC)",3082575,CDM,301,RC,82575,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,9.36,9.36,9.36,"1 through 10","percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.51,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.51,202.5,
".DRUG SCREEN, UA(EFCH)",3000800,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,202.5,
".ENDOMYSIAL IGA",3000670,CDM,301,RC,86255,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,117,
".ENZYMATIC DIGESTION",3083892,CDM,301,RC,83892,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
".FOLATE SERUM (EFCH)",3000807,CDM,301,RC,82746,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.26,120.37,,21.10,21.10,21.10,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.99,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.26,120.37,,14.70,14.70,14.70,"1 through 10","fee schedule","120.37% of GA fee schedule",14.7,100,,14.41,14.41,14.41,"1 through 10","fee schedule","100% of CMS fee schedule",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,180,
".FREE T4",3000544,CDM,301,RC,84439,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.65,120.37,,12.94,12.94,12.94,"1 through 10","fee schedule","120.37% of GA fee schedule",126.45,56.2,,8.93,8.93,8.93,"1 through 10","percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.2,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.2,125.18,,9.02,9.02,9.02,"1 through 10","fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.12,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.02,100,,8.84,8.84,8.84,13,"fee schedule","100% of CMS fee schedule",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.12,202.5,
".GAMMAGLOBULIN (SPEP W IM)",3082784,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,
".GENERAL HEALTH PANEL",3080050,CDM,301,RC,80050,HCPCS,OUTPATIENT,,,1095,876,,930.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",273.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",273.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",273.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",223.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",615.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",618.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",615.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",618.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",383.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",752.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",635.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",223.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",930.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",223.05,985.5,
".GLIADIN IGA",3000660,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,117,
".GLIADIN IGG",3000125,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,117,
".GLUCOSE STRIP/BEDSIDE",3082948,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",67.44,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.44,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,108,
".GTT (TOLERANCE)GLUCOSE",3000137,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.13,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.58,166.5,
".GTT ADDITIONAL",3082952,CDM,301,RC,82952,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.53,135,
".HEPATITIS AMP OF PNA",3000145,CDM,301,RC,81223,HCPCS,OUTPATIENT,,,715,572,,607.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",401.83,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.83,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",403.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",508.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",643.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1201.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",491.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",414.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",607.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",401.83,1201.73,
".IGA,M,G (IMMUNO)",3000175,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,
".IMMUNO G (IgG SUBCLASSES",3082787,CDM,301,RC,82787,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.18,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.02,100,,7.86,7.86,7.86,"1 through 10","fee schedule","100% of CMS fee schedule",8.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.22,103.5,
".IMMUNOASSAY QUANT,NOT SPE",3000164,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,166.5,
".IMMUNOSSAY INFECTIOUS AGENT",3000688,CDM,301,RC,86317,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.89,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,58.5,
".ISOLATION OR EXT NA TPMT",3000630,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
".MICROALBUMIN/CREAT RATIO",3000717,CDM,301,RC,82043,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,5.72,5.72,5.72,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.78,100,,5.66,5.66,5.66,"1 through 10","fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,139.5,
".MOLECULAR AMP TPMT",3000632,CDM,301,RC,83901,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
".MOLECULAR DIAG, ISOL TPMT",3000631,CDM,301,RC,83890,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
".MOLECULAR I&R TPMT",3000633,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
".MUTATION ID TPMT",3000634,CDM,301,RC,81335,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",227.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",168.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",178.31,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",175.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",168.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",174.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.68,227.25,
".OCCULT BLOOD DIGITAL EXAM",3082272,CDM,301,RC,82272,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.86,120.37,,4.09,3.67,4.51,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.31,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.06,125.18,,4.23,4.23,4.23,"1 through 10","fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.81,126,
".OJ AUTOABS",3000622,CDM,301,RC,86235,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,166.5,
".PROTEIN ELECT (IMMUNO)",3000241,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.26,120.37,,15.42,15.42,15.42,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.74,100,,10.53,10.53,10.53,"1 through 10","fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,126,
".PROTIME WITH INR",3000372,CDM,301,RC,85610,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.95,120.37,,5.09,4.51,5.67,"1 through 10","fee schedule","120.37% of GA fee schedule",101.16,56.2,,2.62,2.39,2.85,"1 through 10","percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.18,125.18,,4.29,4.29,4.29,"1 through 10","fee schedule","125.18% of GA fee schedule",123.66,68.7,,121.32,121.32,121.32,"1 through 10","percent of total billed charges","68.7% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.86,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.95,120.37,,4.29,4.29,4.29,"1 through 10","fee schedule","120.37% of GA fee schedule",4.29,100,,4.20,4.20,4.20,"1 through 10","fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.86,162,
".SEX HORMOME GLOBUL",3000644,CDM,301,RC,84270,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.56,153,
".SRP AUTOABS",3000623,CDM,301,RC,86235,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,166.5,
".T 3 UPTAKE (EFCH)",3000804,CDM,301,RC,84479,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,6.34,6.34,6.34,"1 through 10","fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,139.5,
".T PROT ELEC F&Q(SPEP W IM",3000295,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.26,120.37,,15.42,15.42,15.42,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.74,100,,10.53,10.53,10.53,"1 through 10","fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,126,
".T PROTEIN (SPEP W IMMUNO)",3000296,CDM,301,RC,84155,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,5.26,5.26,5.26,"1 through 10","fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.67,100,,3.60,3.60,3.60,"1 through 10","fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,49.5,
".T4 TOTAL (EFCH)",3000805,CDM,301,RC,84436,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,2.89,2.89,2.89,"1 through 10","percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.83,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.41,120.37,,6.87,6.87,6.87,"1 through 10","fee schedule","120.37% of GA fee schedule",6.87,100,,6.73,6.73,6.73,"1 through 10","fee schedule","100% of CMS fee schedule",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.18,117,
".TESTOSTERONE ASSAY",3000643,CDM,301,RC,84402,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.92,153,
".TISSUE CULTURE(CHROM FISH",3000306,CDM,301,RC,88237,HCPCS,OUTPATIENT,,,3400,2720,,2890,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",186.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",133.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1910.8,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",1921,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1910.8,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",1921,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",3060,90,,,,,0,"percent of total billed charges","90% of total billed charges",138.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",2335.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",1972,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",2890,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.38,3060,
".TOTAL IMMUNO G(IgG SUBCLA",3000309,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,103.5,
".TOTAL PSA (PSA 2)",3000346,CDM,301,RC,84153,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,18.20,18.20,18.20,"1 through 10","percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.39,100,,18.02,18.02,18.02,"1 through 10","fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.55,198,
".TRANSFERRIN CARBOHYDRATE",3082373,CDM,301,RC,82373,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.09,198,
".TRANSGLUTAMINASE IGA",3000659,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,117,
".TRIPLE TEST (BETA HCG)",3000313,CDM,301,RC,84702,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,81,
".TRIPLE TEST (ESTRIOL)",3000314,CDM,301,RC,82677,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",36.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.76,225,
".TRIPLE TEST (MAFP)",3000315,CDM,301,RC,82105,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,202.5,
".TSH (THYROID STIM IMMUNOG",3000317,CDM,301,RC,84443,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.84,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.42,120.37,,21.36,19.16,23.55,"1 through 10","fee schedule","120.37% of GA fee schedule",238.85,56.2,,9.96,9.46,16.63,"1 through 10","percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.44,125.18,,16.80,16.80,16.80,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.12,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.42,120.37,,16.80,16.80,16.80,"1 through 10","fee schedule","120.37% of GA fee schedule",16.8,100,,16.46,16.46,16.46,22,"fee schedule","100% of CMS fee schedule",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.12,382.5,
".TSI (THYROID STIM IMMUNOG",3000318,CDM,301,RC,84445,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",51.88,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.33,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",50.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.82,225,
".VIT D 2",3000744,CDM,301,RC,82306,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",44.8,120.37,,42.47,42.47,42.47,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,29.30,29.30,29.30,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",30.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.6,100,,29.01,29.01,29.01,22,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,180,
".VIT D 3",3000745,CDM,301,RC,82306,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",44.8,120.37,,42.47,42.47,42.47,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,29.30,29.30,29.30,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",30.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.6,100,,29.01,29.01,29.01,22,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,180,
".VIT D TOTAL",3000746,CDM,301,RC,82306,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",44.8,120.37,,42.47,42.47,42.47,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,29.30,29.30,29.30,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",30.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.6,100,,29.01,29.01,29.01,22,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,180,
"17 HYDROXYCORTICOSTEROIDS",3083491,CDM,301,RC,83586,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.06,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.52,297,
"17 KETOGENIC STEROID, UA",3083582,CDM,301,RC,83586,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.06,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.52,297,
"17 KETOSTEROIDS, TOTAL",3083586,CDM,301,RC,83586,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.06,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.52,256.5,
"3RD .B-HYDROXYBUTYRATE SERUM",3082010,CDM,301,RC,82010,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.35,135,
"3RD 6-MERCAPTOPURINE",3084291,CDM,301,RC,,,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,612,
"3RD ACETYLCHOLINE RECEPTOR BINDING AB",3084238,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,432,
"3RD ACETYLCHOLINE RECEPTOR BLOCKING AU",3000559,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,247.5,
"3RD ACETYLCHOLINE RECEPTOR MODULATING AB",3000560,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,301.5,
"3RD ADALIMUMAB AND ANTI ADALIMUMAB AB",3000741,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,612,
"3RD ALPHA-1-ANTITRYPSIN",3082103,CDM,301,RC,82104,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.75,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,279,
"3RD AMINO ACID PROFILE,PLASMA",3082128,CDM,301,RC,82128,HCPCS,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.03,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.15,102,,,,,0,"fee schedule","102% of CMS fee schedule",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.82,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.48,1012.5,
"3RD AMINO ACID PROFILE,URINE",3000109,CDM,301,RC,82128,HCPCS,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.03,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.15,102,,,,,0,"fee schedule","102% of CMS fee schedule",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.82,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.48,1012.5,
"3RD AMINOLEVULINIC ACID",3082135,CDM,301,RC,82135,HCPCS,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.39,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.78,102,,,,,0,"fee schedule","102% of CMS fee schedule",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.81,549,
"3RD BK VIRUS QUANT PCR SERUM",3000650,CDM,301,RC,87799,HCPCS,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,670.5,
"3RD BK VIRUS QUANT PCR URINE",3087799,CDM,301,RC,87799,HCPCS,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",260.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",151.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,670.5,
"3RD BORDETELLA PERTUSSIN IGG &IGA ABS",3086615,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",359.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",359.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,576,
"3RD BORDTELLA PERTUSSIS IGM",3000615,CDM,301,RC,86615,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,207,
"3RD CHROMOGRANIN-A",3083519,CDM,301,RC,86316,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,351,
"3RD COBALT BLOOD LEVEL",3000697,CDM,301,RC,83018,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.76,135,
"3RD CORTISOL FREE SERUM",3082531,CDM,301,RC,82530,HCPCS,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.72,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",528.28,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",528.28,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.71,100,,16.38,16.38,16.38,"1 through 10","fee schedule","100% of CMS fee schedule",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,846,
"3RD CREATINE 24 HR URINE",3082540,CDM,301,RC,82540,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.73,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.3,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.18,297,
"3RD CYCLOSPORINE",3080158,CDM,301,RC,80158,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.47,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.41,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.39,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.03,432,
"3RD CYSTIC FIBROSIS BUCAL SME",3083898,CDM,301,RC,81223,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",508.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1201.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.63,1201.73,
"3RD EBV DNA QUANTITATIVE",3000899,CDM,301,RC,87798,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,612,
"3RD GABAPENTIN",3000222,CDM,301,RC,80171,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.17,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,324,
"3RD GLUCOSE BODY FLUID",3082945,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,135,
"3RD GLUTAMIC ACID DECARBOXYLA",3000133,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,535.5,
"3RD HAPTOGLOBIN LEVEL",3083010,CDM,301,RC,83010,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.35,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.32,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.65,243,
"3RD HEPATITIS D VIRUS IGM AB",3000629,CDM,301,RC,86692,HCPCS,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",460.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,90,,,,,0,"fee schedule","90% of CMS fee schedule",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,738,
"3RD HISTAMINE LEVEL",3083088,CDM,301,RC,83088,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.39,130,,,,,0,"fee schedule","130% of CMS fee schedule",44.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",30.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.58,463.5,
"3RD IA-2 ANTIBODY",3086342,CDM,301,RC,86341,HCPCS,OUTPATIENT,,,1110,888,,943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",623.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",623.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",627.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",999,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",762.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,90,,,,,0,"fee schedule","90% of CMS fee schedule",643.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",943.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,999,
"3RD LAMICTAL LEVEL",3000183,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,351,
"3RD LAMOTRIGINE LEVEL",3000184,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,346.5,
"3RD LDH BODY FLUID",3000545,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.44,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.44,198,
"3RD METANEPHRINES,PLASMA",3000196,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,1640,1312,,1394,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",921.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",926.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",921.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",926.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",1476,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1126.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",951.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",1394,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,1476,
"3RD METHYLMALONIC ACID SERUM",3083921,CDM,301,RC,83921,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.09,490.5,
"3RD METHYLMALONIC ACID URINE",3000653,CDM,301,RC,83921,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.09,490.5,
"3RD MYLELIN ANTIBODY IGG",3086255,CDM,301,RC,86255,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,180,
"3RD PANCREATIC ELASTASE",3000691,CDM,301,RC,82656,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",186.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",514.23,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",514.23,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,823.5,
"3RD PH BODY FLUID NOT BLOOD",3000342,CDM,301,RC,83986,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.22,58.5,
"3RD PORPHYRIN FRACTIONATED 24 URINE",3000549,CDM,301,RC,84120,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,274.5,
"3RD PORPHYRIN RANDOM URINE",3000235,CDM,301,RC,84106,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.94,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,274.5,
"3RD PORPHYRINS PLASMA",3000614,CDM,301,RC,80367,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,,,,0,"percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",114.07,504,
"3RD PREGNANCY BETA (QUANT)",3084702,CDM,301,RC,84702,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,297,
"3RD REDUCING SUBSTANCES,STOOL",3000254,CDM,301,RC,84999,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"3RD TACROLIMUS LEVEL",3080197,CDM,301,RC,80197,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.36,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.73,100,,13.46,13.46,13.46,"1 through 10","fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.36,387,
"3RD TOPIRAMATE (TOPAMAX) LEVEL",3080201,CDM,301,RC,80201,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.73,387,
"3RD TPMT LEVEL",3000711,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,670.5,
"3RD TRYPSIN LEVEL",3000580,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,508.5,
"3RD VON WILLENBRAND ANTIGEN",3085246,CDM,301,RC,85246,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",23.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,229.5,
"3RD ZONISAMIDE (ZONEGRAN) LEVEL",3000339,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,369,
"5 HIAA, UA",3083497,CDM,301,RC,83497,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,279,
"ABG (ARTERIAL BLOOD GASES)",5582803,CDM,301,RC,82803,HCPCS,OUTPATIENT,,,490,392,,416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.3,120.37,,21.45,21.45,21.45,"1 through 10","fee schedule","120.37% of GA fee schedule",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",441,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.47,125.18,,26.07,26.07,26.07,"1 through 10","fee schedule","125.18% of GA fee schedule",336.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",284.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.3,120.37,,26.07,26.07,26.07,"1 through 10","fee schedule","120.37% of GA fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,441,
"ACE LEVEL",3082164,CDM,301,RC,82164,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.6,100,,14.31,14.31,14.31,"1 through 10","fee schedule","100% of CMS fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.14,229.5,
"ACETAMINOPHEN (SERUM TEST)",3082003,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.86,125.18,,28.47,28.47,28.47,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,382.5,
"ACETAMINOPHEN (SERUM TEST) S",3080001,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.86,125.18,,28.47,28.47,28.47,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,382.5,
"ACETONE, SERUM",3082009,CDM,301,RC,82009,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.97,120.37,,2.36,1.33,3.39,"1 through 10","fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.97,120.37,,4.52,4.52,4.52,"1 through 10","fee schedule","120.37% of GA fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.07,58.5,
ACTH,3082024,CDM,301,RC,82024,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",58.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",39.39,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.76,432,
"ALBUMIN, OTHER",3082042,CDM,301,RC,82042,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.94,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7,135,
"ALBUMIN, SERUM",3082040,CDM,301,RC,82040,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.44,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.05,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.53,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.36,135,
"ALBUMIN, SERUM S",3080002,CDM,301,RC,82040,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.44,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.05,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.53,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.36,135,
"ALCOHOL (SERUM TEST)",3082055,CDM,301,RC,80320,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.36,120.37,,14.74,14.74,14.74,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.36,382.5,
"ALCOHOL (SERUM TEST) S",3080040,CDM,301,RC,80320,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.36,120.37,,14.74,14.74,14.74,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.36,382.5,
ALDOLASE,3082085,CDM,301,RC,82085,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,225,
"ALDOSTERONE, SERUM",3000001,CDM,301,RC,82088,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",61.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",41.57,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.68,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.68,324,
"ALDOSTERONE, URINE",3000002,CDM,301,RC,82088,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",61.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",41.57,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.68,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.68,490.5,
"ALDOSTERONE/RENIN RATIO",3000673,CDM,301,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"ALK PHOSP",3084075,CDM,301,RC,84075,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,139.5,
"ALK PHOSP S",3080003,CDM,301,RC,84075,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,139.5,
"ALKALINE PHOSPHATASE ISO",3084080,CDM,301,RC,84080,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.3,243,
"ALPHA FETOPROTEIN TUMOR M",3000003,CDM,301,RC,82105,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,297,
"ALPHA FETOPROTEIN, MATERN",3000004,CDM,301,RC,82105,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,297,
"ALPHA-1-ANTITRYPSIN STOOL",3000611,CDM,301,RC,82103,HCPCS,OUTPATIENT,,,490,392,,416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",441,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",336.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",284.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.1,441,
"ALUMINUM LEVEL",3082108,CDM,301,RC,82108,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.99,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,225,
"AMIKACIN PEAK",3000587,CDM,301,RC,80150,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,256.5,
"AMIKACIN TROUGH",3080150,CDM,301,RC,80150,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,256.5,
AMIODARONE,3080299,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,391.5,
"AMMONIA LEVEL",3082140,CDM,301,RC,82140,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.94,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.97,120.37,,11.49,9.31,13.66,"1 through 10","fee schedule","120.37% of GA fee schedule",238.85,56.2,,6.48,5.90,7.06,"1 through 10","percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.57,125.18,,13.92,13.92,13.92,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.97,120.37,,13.92,13.92,13.92,"1 through 10","fee schedule","120.37% of GA fee schedule",14.57,100,,14.28,14.28,14.28,"1 through 10","fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.11,382.5,
"AMMONIA LEVEL S",3080039,CDM,301,RC,82140,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.94,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.97,120.37,,11.49,9.31,13.66,"1 through 10","fee schedule","120.37% of GA fee schedule",238.85,56.2,,6.48,5.90,7.06,"1 through 10","percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.57,125.18,,13.92,13.92,13.92,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.97,120.37,,13.92,13.92,13.92,"1 through 10","fee schedule","120.37% of GA fee schedule",14.57,100,,14.28,14.28,14.28,"1 through 10","fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.11,382.5,
"AMYLASE ISOENYZMES",3082150,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.42,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.81,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",188.27,56.2,,3.84,3.70,4.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.2,125.18,,6.48,6.48,6.48,"1 through 10","fee schedule","125.18% of GA fee schedule",230.15,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,90,,,,,0,"fee schedule","90% of CMS fee schedule",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.81,120.37,,6.48,4.04,6.48,"1 through 10","fee schedule","120.37% of GA fee schedule",6.48,100,,6.35,6.35,6.35,"1 through 10","fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,301.5,
"AMYLASE, FLUID",3000006,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.42,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.81,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,3.84,3.70,4.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.2,125.18,,6.48,6.48,6.48,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.81,120.37,,6.48,4.04,6.48,"1 through 10","fee schedule","120.37% of GA fee schedule",6.48,100,,6.35,6.35,6.35,"1 through 10","fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,279,
"AMYLASE, SERUM",3000007,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.42,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.81,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,3.84,3.70,4.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.2,125.18,,6.48,6.48,6.48,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.81,120.37,,6.48,4.04,6.48,"1 through 10","fee schedule","120.37% of GA fee schedule",6.48,100,,6.35,6.35,6.35,"1 through 10","fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,279,
"AMYLASE, SERUM S",3080005,CDM,301,RC,82150,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.42,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.81,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,3.84,3.70,4.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.2,125.18,,6.48,6.48,6.48,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.81,120.37,,6.48,4.04,6.48,"1 through 10","fee schedule","120.37% of GA fee schedule",6.48,100,,6.35,6.35,6.35,"1 through 10","fee schedule","100% of CMS fee schedule",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.83,279,
ANDROSTENEDIONE,3082157,CDM,301,RC,82157,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.06,130,,,,,0,"fee schedule","130% of CMS fee schedule",44.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",29.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.35,81,
"ANTI HU AUTO",3000013,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,346.5,
"ANTI MAG",3000015,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,706.5,
"APOE GENOTYPE",3000586,CDM,301,RC,81401,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",178.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",134.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",139.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",140.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",137,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.3,490.5,
"ARSENIC, BLOOD",3000637,CDM,301,RC,82175,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.07,153,
"ARSENIC, OTHER",3083015,CDM,301,RC,82175,HCPCS,OUTPATIENT,,,630,504,,535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",354.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",354.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",432.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",365.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.07,567,
"ARSENIC, URINE 24 HR",3082175,CDM,301,RC,82175,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.07,342,
B-12,3082607,CDM,301,RC,82607,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,6.62,6.11,7.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.81,120.37,,15.08,15.08,15.08,"1 through 10","fee schedule","120.37% of GA fee schedule",15.08,100,,14.78,14.78,14.78,"1 through 10","fee schedule","100% of CMS fee schedule",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.57,180,
"B-12 BINDING CAPACITY",3082608,CDM,301,RC,82608,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.89,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.89,180,
"BARBITURATES QUANTITATIVE,SERUM",3082205,CDM,301,RC,,,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"BASIC METABOLIC PNL",3080048,CDM,301,RC,80048,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",11,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.82,120.37,,12.15,8.44,12.44,"1 through 10","fee schedule","120.37% of GA fee schedule",244.47,56.2,,6.26,5.01,8.37,"1 through 10","percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.33,125.18,,8.46,8.46,8.46,"1 through 10","fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.82,120.37,,8.46,8.46,8.46,"1 through 10","fee schedule","120.37% of GA fee schedule",8.46,100,,8.29,8.29,8.29,24,"fee schedule","100% of CMS fee schedule",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.61,391.5,
"BASIC METABOLIC PNL S",3080055,CDM,301,RC,80048,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",11,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.82,120.37,,12.15,8.44,12.44,"1 through 10","fee schedule","120.37% of GA fee schedule",244.47,56.2,,6.26,5.01,8.37,"1 through 10","percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.33,125.18,,8.46,8.46,8.46,"1 through 10","fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.82,120.37,,8.46,8.46,8.46,"1 through 10","fee schedule","120.37% of GA fee schedule",8.46,100,,8.29,8.29,8.29,24,"fee schedule","100% of CMS fee schedule",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.61,391.5,
"BENZODIAZEPINE, SERUM",3080154,CDM,301,RC,80346,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",140,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,504,
"BENZODIAZEPINE, UA",3000029,CDM,301,RC,80346,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,243,
BETA-2-MICROGLOBULIN,3082232,CDM,301,RC,82232,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.03,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.56,256.5,
"BILIRUBIN, DIRECT",3082248,CDM,301,RC,82248,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.02,100,,4.92,4.92,4.92,"1 through 10","fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,166.5,
"BILIRUBIN, DIRECT S",3080014,CDM,301,RC,82248,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.02,100,,4.92,4.92,4.92,"1 through 10","fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,166.5,
"BILIRUBIN, TOTAL",3082247,CDM,301,RC,82247,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,166.5,
"BILIRUBIN, TOTAL S",3080031,CDM,301,RC,82247,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,166.5,
BNP,3083880,CDM,301,RC,83880,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",39.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",51.39,120.37,,48.71,39.83,49.85,"1 through 10","fee schedule","120.37% of GA fee schedule",244.47,56.2,,22.63,20.62,24.64,"1 through 10","percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",40.05,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",53.44,125.18,,39.26,39.26,39.26,"1 through 10","fee schedule","125.18% of GA fee schedule",298.85,68.7,,169.65,169.65,169.65,"1 through 10","percent of total billed charges","68.7% of total billed charges",39.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.39,120.37,,39.26,14.37,39.26,"1 through 10","fee schedule","120.37% of GA fee schedule",39.26,100,,38.47,38.47,38.47,"1 through 10","fee schedule","100% of CMS fee schedule",39.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",39.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,391.5,
"BUN SERUM",3084520,CDM,301,RC,84520,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.56,139.5,
"BUN SERUM S",3080007,CDM,301,RC,84520,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.56,139.5,
"BUN URINE",3084540,CDM,301,RC,84540,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.67,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",5,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",5,139.5,
"C PEPTIDE",3084681,CDM,301,RC,84681,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,387,
"C- PEPTIDE",3000229,CDM,301,RC,84681,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,387,
"CADMIUM URINE",3082300,CDM,301,RC,82300,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",35.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.28,81,
CALCITONIN,3082308,CDM,301,RC,82308,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.83,130,,,,,0,"fee schedule","130% of CMS fee schedule",40.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",42.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.11,387,
"CALCIUM IONIZED",3082330,CDM,301,RC,82330,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.31,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.31,184.5,
"CALCIUM SERUM",3082310,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,139.5,
"CALCIUM SERUM S",3080008,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,139.5,
"CALCIUM URINE SPOT",3000037,CDM,301,RC,82310,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.64,139.5,
"CARBAMAZEPINE (TEGRETOL) LEVEL",3000038,CDM,301,RC,80156,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.94,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.92,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.11,297,
"CARBOXYHEMOGLOBIN LEVEL",3082375,CDM,301,RC,82375,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.57,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.53,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.36,225,
"CAROTENE, SERUM",3082380,CDM,301,RC,82380,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.3,243,
"CATECHOLAMINE UA 24 HR",3000646,CDM,301,RC,82384,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.83,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.74,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.73,387,
"CATECHOLAMINE UA RANDOM",3082384,CDM,301,RC,82384,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.83,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.74,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.73,387,
"CATECHOLAMINES PLASMA",3000039,CDM,301,RC,82384,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.83,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.74,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.73,387,
"CATHARTIC SCREEN STOOL",3000292,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.14,120.37,,8.52,7.64,9.39,"1 through 10","fee schedule","120.37% of GA fee schedule",441.17,56.2,,2.65,2.57,3.31,16,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",539.3,68.7,,87.39,87.39,87.39,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.14,120.37,,6.70,6.70,6.70,13,"fee schedule","120.37% of GA fee schedule",6.7,100,,6.57,6.57,6.57,"1 through 10","fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,706.5,
CEA,3082378,CDM,301,RC,82378,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.34,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,342,
CERULOPLASMIN,3082390,CDM,301,RC,82390,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,225,
"CHLORIDE  SERUM",3082435,CDM,301,RC,82435,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.69,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.14,135,
"CHLORIDE  SERUM S",3080011,CDM,301,RC,82435,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.69,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.14,135,
"CHLORIDE BODY FLUID",3082438,CDM,301,RC,82438,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.5,135,
"CHLORIDE URINE 24 HR",3000706,CDM,301,RC,82436,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,135,
"CHLORIDE URINE SPOT",3082436,CDM,301,RC,82436,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,135,
"CHLORIDE URINE SPOT S",3080041,CDM,301,RC,82436,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,135,
CHOLESTEROL,3082465,CDM,301,RC,82465,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.44,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,166.5,
"CHOLESTEROL S",3080009,CDM,301,RC,82465,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.44,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.92,166.5,
"CHOLINESTERASE, PLASMA",3082480,CDM,301,RC,82480,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.08,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.08,297,
"CHOLINESTERASE, RBC",3082482,CDM,301,RC,82482,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.75,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.83,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.83,297,
"CHOLINESTERASE, SERUM",3000048,CDM,301,RC,82480,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.08,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.08,297,
"CHROMIUM RBC LEVEL",3082495,CDM,301,RC,82495,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.69,102,,,,,0,"fee schedule","102% of CMS fee schedule",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.93,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.25,112.5,
CHYLOMICRONS,3000578,CDM,301,RC,82664,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.95,130,,,,,0,"fee schedule","130% of CMS fee schedule",52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",62.73,102,,,,,0,"fee schedule","102% of CMS fee schedule",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",52,612,
"CITRATE URINE",3082507,CDM,301,RC,82507,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",42.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",28.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.02,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.02,432,
CK-MB,3082553,CDM,301,RC,82553,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.48,120.37,,11.52,10.50,12.54,"1 through 10","fee schedule","120.37% of GA fee schedule",171.41,56.2,,5.13,4.67,5.59,"1 through 10","percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.78,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.18,125.18,,11.55,11.55,11.55,"1 through 10","fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.4,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.48,120.37,,11.55,11.55,11.55,"1 through 10","fee schedule","120.37% of GA fee schedule",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.4,274.5,
"CLONAZEPAM LEVEL",3000054,CDM,301,RC,80367,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"CLONAZEPAM LEVEL",3000709,CDM,301,RC,80346,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,297,
CLOZAPINE,3000056,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,342,
"CMP (BMP ALREADY DONE)",3000369,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",16,120.37,,15.17,12.40,15.52,"1 through 10","fee schedule","120.37% of GA fee schedule",317.53,56.2,,5.09,4.40,7.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.64,125.18,,10.56,10.56,10.56,"1 through 10","fee schedule","125.18% of GA fee schedule",388.16,68.7,,220.35,220.35,220.35,"1 through 10","percent of total billed charges","68.7% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16,120.37,,10.56,10.56,10.56,24,"fee schedule","120.37% of GA fee schedule",10.56,100,,10.35,10.35,10.35,62,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,508.5,
"CMP (BMP ALREADY DONE) S",3080057,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",16,120.37,,15.17,12.40,15.52,"1 through 10","fee schedule","120.37% of GA fee schedule",317.53,56.2,,5.09,4.40,7.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.64,125.18,,10.56,10.56,10.56,"1 through 10","fee schedule","125.18% of GA fee schedule",388.16,68.7,,220.35,220.35,220.35,"1 through 10","percent of total billed charges","68.7% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16,120.37,,10.56,10.56,10.56,24,"fee schedule","120.37% of GA fee schedule",10.56,100,,10.35,10.35,10.35,62,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,508.5,
"CMP MULLINS",3000392,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",16,120.37,,15.17,12.40,15.52,"1 through 10","fee schedule","120.37% of GA fee schedule",261.33,56.2,,5.09,4.40,7.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.64,125.18,,10.56,10.56,10.56,"1 through 10","fee schedule","125.18% of GA fee schedule",319.46,68.7,,220.35,220.35,220.35,"1 through 10","percent of total billed charges","68.7% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16,120.37,,10.56,10.56,10.56,24,"fee schedule","120.37% of GA fee schedule",10.56,100,,10.35,10.35,10.35,62,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,418.5,
CO2,3082374,CDM,301,RC,82374,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.34,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,126,
"CO2 S",3080012,CDM,301,RC,82374,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.34,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,126,
CODEINE,3082101,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,279,
"COMP METABOLIC PNL",3080053,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",16,120.37,,15.17,12.40,15.52,"1 through 10","fee schedule","120.37% of GA fee schedule",317.53,56.2,,5.09,4.40,7.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.64,125.18,,10.56,10.56,10.56,"1 through 10","fee schedule","125.18% of GA fee schedule",388.16,68.7,,220.35,220.35,220.35,"1 through 10","percent of total billed charges","68.7% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16,120.37,,10.56,10.56,10.56,24,"fee schedule","120.37% of GA fee schedule",10.56,100,,10.35,10.35,10.35,62,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,508.5,
"COMP METABOLIC PNL S",3080056,CDM,301,RC,80053,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",16,120.37,,15.17,12.40,15.52,"1 through 10","fee schedule","120.37% of GA fee schedule",317.53,56.2,,5.09,4.40,7.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.64,125.18,,10.56,10.56,10.56,"1 through 10","fee schedule","125.18% of GA fee schedule",388.16,68.7,,220.35,220.35,220.35,"1 through 10","percent of total billed charges","68.7% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16,120.37,,10.56,10.56,10.56,24,"fee schedule","120.37% of GA fee schedule",10.56,100,,10.35,10.35,10.35,62,"fee schedule","100% of CMS fee schedule",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.5,508.5,
"COPPER LEVEL",3082525,CDM,301,RC,82525,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.17,207,
"COPPER LEVEL 24 HR URINE",3000395,CDM,301,RC,82525,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.17,207,
"CORTISOL EVENING",3000388,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.3,100,,15.97,15.97,15.97,"1 through 10","fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.67,297,
"CORTISOL FREE URINE 24 HR",3082530,CDM,301,RC,82530,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.72,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.71,100,,16.38,16.38,16.38,"1 through 10","fee schedule","100% of CMS fee schedule",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,351,
"CORTISOL MORNING",3000387,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.3,100,,15.97,15.97,15.97,"1 through 10","fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.67,297,
"CORTISOL RANDOM",3082533,CDM,301,RC,82533,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.3,100,,15.97,15.97,15.97,"1 through 10","fee schedule","100% of CMS fee schedule",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.67,297,
CPK,3082550,CDM,301,RC,82550,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.46,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,5.60,5.60,5.60,"1 through 10","fee schedule","120.37% of GA fee schedule",123.64,56.2,,3.86,3.69,4.53,"1 through 10","percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.86,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,6.51,6.51,6.51,"1 through 10","fee schedule","120.37% of GA fee schedule",6.51,100,,6.38,6.38,6.38,"1 through 10","fee schedule","100% of CMS fee schedule",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.86,198,
"CPK ISOENZYMES",3082552,CDM,301,RC,82552,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.39,100,,13.12,13.12,13.12,"1 through 10","fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,297,
"CPK S",3080010,CDM,301,RC,82550,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.46,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,5.60,5.60,5.60,"1 through 10","fee schedule","120.37% of GA fee schedule",123.64,56.2,,3.86,3.69,4.53,"1 through 10","percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.86,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,6.51,6.51,6.51,"1 through 10","fee schedule","120.37% of GA fee schedule",6.51,100,,6.38,6.38,6.38,"1 through 10","fee schedule","100% of CMS fee schedule",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.86,198,
"CREATININE, SERUM",3082565,CDM,301,RC,82565,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,2.09,1.94,2.42,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,5.12,5.12,5.12,"1 through 10","fee schedule","120.37% of GA fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.61,139.5,
"CREATININE, SERUM S",3080013,CDM,301,RC,82565,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,2.09,1.94,2.42,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,5.12,5.12,5.12,"1 through 10","fee schedule","120.37% of GA fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.61,139.5,
"CREATININE, URINE SPOT",3000061,CDM,301,RC,82570,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,5.13,5.13,5.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,5.18,5.18,5.18,"1 through 10","fee schedule","120.37% of GA fee schedule",5.18,100,,5.08,5.08,5.08,50,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,139.5,
"CREATININE, URINE SPOT S",3080042,CDM,301,RC,82570,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,5.13,5.13,5.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,5.18,5.18,5.18,"1 through 10","fee schedule","120.37% of GA fee schedule",5.18,100,,5.08,5.08,5.08,50,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,139.5,
CRYOFIBRINOGEN,3082585,CDM,301,RC,82585,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.38,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.73,432,
"CRYOGLOBULIN, QUALITATIVE",3082595,CDM,301,RC,82595,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,126,
"CRYPTOCOCCUS AB",3086641,CDM,301,RC,86641,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.97,81,
"CULTURE BORDETELLA PERTUSSIS",3000616,CDM,301,RC,87081,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,207,
"CYSTATIN C",3082610,CDM,301,RC,82610,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.08,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,139.5,
"DARVON LEVEL",3000082,CDM,301,RC,80367,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",77.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",133,35,,,,,0,"percent of total billed charges","35% of total billed charges",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",77.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",77.41,342,
"DESIPRAMINE LEVEL",3080160,CDM,301,RC,80335,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.1,274.5,
"DESYREL  LEVEL",3000084,CDM,301,RC,80338,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",86.57,382.5,
DHEA,3082626,CDM,301,RC,82626,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.78,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.74,324,
DHEA-S,3082627,CDM,301,RC,82627,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.9,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.67,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.01,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.01,324,
"DIGOXIN (LANOXIN) LEVEL",3080162,CDM,301,RC,80162,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.26,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.28,100,,13.01,13.01,13.01,"1 through 10","fee schedule","100% of CMS fee schedule",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.95,342,
"DIGOXIN (LANOXIN) LEVEL S",3080015,CDM,301,RC,80162,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.26,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.28,100,,13.01,13.01,13.01,"1 through 10","fee schedule","100% of CMS fee schedule",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.95,342,
"DILANTIN LEVEL",3080185,CDM,301,RC,80185,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.52,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.25,100,,12.98,12.98,12.98,"1 through 10","fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,297,
"DILANTIN LEVEL S",3080029,CDM,301,RC,80185,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.52,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.25,100,,12.98,12.98,12.98,"1 through 10","fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,297,
"DILANTIN,FREE LEVEL",3080186,CDM,301,RC,80186,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.67,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.38,247.5,
"DIRECT LDL",3083721,CDM,301,RC,83721,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.45,135,
"DISOPYRAMIDE LEVEL",3000085,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,256.5,
"DIURETIC PANEL, URINE",3082492,CDM,301,RC,82775,HCPCS,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.39,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,90,,,,,0,"fee schedule","90% of CMS fee schedule",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,549,
"DRUG SCR UA CONF (EFCH)",3000815,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,165,132,,140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",92.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",93.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",148.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",113.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",95.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,148.5,
"DRUG SCREEN CONFIRM Ua ea",3000088,CDM,301,RC,80375,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.97,166.5,
"DRUG SCREEN EMH CONTRACT",3000710,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"DRUG SCREEN STUDENT,UA",3000612,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DRUG SCREEN, 5 PANEL QUEST",3000667,CDM,301,RC,80376,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DRUG SCREEN, COMPREHEN UA",3000089,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,315,
"DRUG SCREEN, DFACS",3000647,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",47.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",47.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.77,80.78,
"DRUG SCREEN, INDUS I,UA",3000090,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"DRUG SCREEN, NIDA",3000091,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"DRUG SCREEN, REGULAR QUEST",3000092,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DRUG SCREEN, UA (MEDICAL)",3000093,CDM,301,RC,G0481,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",156.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",156.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",156.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",203.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",155.02,120.37,,146.98,120.18,150.44,"1 through 10","fee schedule","120.37% of GA fee schedule",126.45,56.2,,38.91,37.08,40.73,"1 through 10","percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",159.72,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",161.22,125.18,,144.09,144.09,144.09,"1 through 10","fee schedule","125.18% of GA fee schedule",154.58,68.7,,87.75,87.75,87.75,"1 through 10","percent of total billed charges","68.7% of total billed charges",156.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",155.02,120.37,,144.09,28.40,144.09,"1 through 10","fee schedule","120.37% of GA fee schedule",156.59,100,,153.46,153.46,153.46,"1 through 10","fee schedule","100% of CMS fee schedule",156.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",156.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.45,203.57,
"DRUG SCREEN,SERUM(9 PANEL)",3000568,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DRUG SCREEN/W ETOH",3000605,CDM,301,RC,80377,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"DUST MITE D1",3000603,CDM,301,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"ELAVIL LEVEL",3080152,CDM,301,RC,80152,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
ELECTROLYTES,3080051,CDM,301,RC,80051,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.15,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.31,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.31,324,
"ELECTROLYTES S",3080060,CDM,301,RC,80051,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.15,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.31,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.31,324,
"ELECTROPHORETIC TECHNIQUE",3082664,CDM,301,RC,82664,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.95,130,,,,,0,"fee schedule","130% of CMS fee schedule",52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",62.73,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",52,324,
"ER GLUCOSE STRIP/BEDSIDE",3082958,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,153,
ERYTHROPOIETIN,3082668,CDM,301,RC,82668,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.17,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.58,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.91,342,
ESTRADIOL,300799,CDM,301,RC,82670,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.32,130,,,,,0,"fee schedule","130% of CMS fee schedule",42.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",28.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.99,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.15,418.5,
"ESTRIOL, TOTAL",3082677,CDM,301,RC,82677,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",36.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.76,324,
ESTROGEN,3082670,CDM,301,RC,82670,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.32,130,,,,,0,"fee schedule","130% of CMS fee schedule",42.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",28.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.99,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.15,418.5,
"ESTRONE LEVEL",3082679,CDM,301,RC,82679,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.44,130,,,,,0,"fee schedule","130% of CMS fee schedule",37.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.46,387,
ETHOSUXIMIDE,3080168,CDM,301,RC,80168,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.24,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.67,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,274.5,
"ETHYLENE GLYCOL",3082693,CDM,301,RC,82693,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.37,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.2,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.46,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.41,351,
"EVANS PNP PRFLE",3000104,CDM,301,RC,80055,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",48.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",35.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.8,391.5,
FELBAMATE,3000662,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,180,
"FERRITIN, SERUM",3082728,CDM,301,RC,82728,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.72,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.62,120.37,,19.55,19.55,19.55,"1 through 10","fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.44,125.18,,13.63,13.63,13.63,"1 through 10","fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.63,100,,13.36,13.36,13.36,11,"fee schedule","100% of CMS fee schedule",13.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,202.5,
"FIBRO TEST",3081596,CDM,301,RC,81596,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",93.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",69.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",73.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",69.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.97,342,
"FINGERSTICK BLOOD SUGAR",3082956,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,153,
"FIORINAL LEVEL",3000034,CDM,301,RC,80345,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.35,508.5,
"FLECAINIDE LEVEL",3000112,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,243,
"FOLATE SERUM",3082746,CDM,301,RC,82746,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.26,120.37,,21.10,21.10,21.10,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.99,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.26,120.37,,14.70,14.70,14.70,"1 through 10","fee schedule","120.37% of GA fee schedule",14.7,100,,14.41,14.41,14.41,"1 through 10","fee schedule","100% of CMS fee schedule",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,180,
"FREE T3",3084481,CDM,301,RC,84481,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.64,120.37,,24.31,24.31,24.31,"1 through 10","fee schedule","120.37% of GA fee schedule",143.31,56.2,,16.77,16.77,16.77,"1 through 10","percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.94,100,,16.60,16.60,16.60,"1 through 10","fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,229.5,
"FREE T4",3084439,CDM,301,RC,84439,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.65,120.37,,12.94,12.94,12.94,"1 through 10","fee schedule","120.37% of GA fee schedule",126.45,56.2,,8.93,8.93,8.93,"1 through 10","percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.2,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.2,125.18,,9.02,9.02,9.02,"1 through 10","fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.12,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.02,100,,8.84,8.84,8.84,13,"fee schedule","100% of CMS fee schedule",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.12,202.5,
"FRUCTOSAMINE LEVEL",3082985,CDM,301,RC,82985,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,202.5,
"FRUCTOSE SEMEN",3082757,CDM,301,RC,82757,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.54,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.69,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.61,342,
"FSH SERUM",3083001,CDM,301,RC,83001,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.72,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.72,351,
"G6PD QUANT",3082955,CDM,301,RC,82955,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.61,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,256.5,
"GALACTOSE 1-PHOSPHATE URIDYLTRANSFERASE",3000231,CDM,301,RC,82775,HCPCS,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.39,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",460.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,90,,,,,0,"fee schedule","90% of CMS fee schedule",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.96,738,
"GAMMA-HYDROXY ACID URINE",3000119,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,670.5,
"GASTRIN, SERUM",3082941,CDM,301,RC,82941,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.87,243,
"GD1a IgG",3000123,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,351,
"GD1a IgM",3000122,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,490.5,
"GENTAMICIN PEAK",3080172,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,297,
"GENTAMICIN PEAK S",3080019,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,297,
"GENTAMICIN RANDOM",3080170,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,297,
"GENTAMICIN RANDOM S",3080017,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,297,
"GENTAMICIN TROUGH",3080175,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,297,
"GENTAMICIN TROUGH S",3080018,CDM,301,RC,80170,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.74,297,
GGT,3082977,CDM,301,RC,82977,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.34,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.2,100,,7.06,7.06,7.06,"1 through 10","fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,166.5,
"GGT S",3080020,CDM,301,RC,82977,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.34,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.2,100,,7.06,7.06,7.06,"1 through 10","fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,166.5,
"GLIADIN ANTIBODY IgA",3083520,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,274.5,
"GLIADIN ANTIBODY IgG",3000802,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,274.5,
GLUCAGON,3082943,CDM,301,RC,82943,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.58,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.86,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.86,324,
"GLUCOSE 1 HR POST DOSE OB",3082950,CDM,301,RC,82950,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.18,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,135,
"GLUCOSE 2 HR POST DOSE OB",3000127,CDM,301,RC,82950,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.18,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,135,
"GLUCOSE CSF",3000132,CDM,301,RC,82945,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,135,
"GLUCOSE S",3082011,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,5.63,5.63,5.63,"1 through 10","fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,4.91,4.91,4.91,"1 through 10","percent of total billed charges","68.7% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,135,
"GLUCOSE SERUM",3082947,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,5.63,5.63,5.63,"1 through 10","fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,4.91,4.91,4.91,"1 through 10","percent of total billed charges","68.7% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,135,
"GLUCOSE SERUM S",3080021,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,5.63,5.63,5.63,"1 through 10","fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,4.91,4.91,4.91,"1 through 10","percent of total billed charges","68.7% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,135,
"GLUCOSE TOLERANCE 2H",3082951,CDM,301,RC,82951,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.13,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.58,166.5,
"GM1 IgG",3000345,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,490.5,
"GROWTH HORMONE LEVEL",3083003,CDM,301,RC,83003,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",15,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",15,297,
"H PYLORI BREATH TEST",3083013,CDM,301,RC,83013,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",80.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",68.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",83.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",67.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.62,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",80.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",67.36,100,,66.01,66.01,66.01,"1 through 10","fee schedule","100% of CMS fee schedule",67.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.62,135,
"HALDOL LEVEL",3000141,CDM,301,RC,80173,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.92,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.2,346.5,
"HALOPERIDOL LEVEL",3080173,CDM,301,RC,80173,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.92,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.2,346.5,
HDL,3083718,CDM,301,RC,83718,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.89,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.37,126,
"HDL S",3080022,CDM,301,RC,83718,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.89,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.37,126,
"HEAVY METALS (BLOOD)",3083018,CDM,301,RC,83018,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.76,184.5,
"HEAVY METALS (URINE)",3000142,CDM,301,RC,83015,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.22,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.64,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.85,184.5,
"HEMOGLOBIN A1C",3083036,CDM,301,RC,83036,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.69,120.37,,13.92,13.92,13.92,"1 through 10","fee schedule","120.37% of GA fee schedule",143.31,56.2,,9.61,6.33,9.61,"1 through 10","percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.27,125.18,,9.71,9.71,9.71,"1 through 10","fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.71,100,,9.52,9.52,9.52,20,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,229.5,
"HEMOGLOBIN A1C S",3080054,CDM,301,RC,83036,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.69,120.37,,13.92,13.92,13.92,"1 through 10","fee schedule","120.37% of GA fee schedule",143.31,56.2,,9.61,6.33,9.61,"1 through 10","percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.27,125.18,,9.71,9.71,9.71,"1 through 10","fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.71,100,,9.52,9.52,9.52,20,"fee schedule","100% of CMS fee schedule",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,229.5,
"HEMOGLOBIN ELECTROPHORESIS",3083020,CDM,301,RC,83021,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.09,297,
"HEPATIC FUNCT PANEL(LIVER",3080076,CDM,301,RC,80076,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,8.08,8.08,8.08,"1 through 10","percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.17,100,,8.01,8.01,8.01,"1 through 10","fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.35,382.5,
"HEPATIC FUNCT PANEL(LIVER S",3080059,CDM,301,RC,80076,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,8.08,8.08,8.08,"1 through 10","percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.87,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.17,100,,8.01,8.01,8.01,"1 through 10","fee schedule","100% of CMS fee schedule",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.35,382.5,
"HEPATITIS PROFILE",3080074,CDM,301,RC,80074,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",72.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",334.39,56.2,,19.33,19.33,19.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",48.58,102,,,,,0,"fee schedule","102% of CMS fee schedule",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",74.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",47.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",72.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",47.63,100,,46.68,46.68,46.68,"1 through 10","fee schedule","100% of CMS fee schedule",47.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.87,535.5,
"HOMOCYSTEINE, SERUM",3083090,CDM,301,RC,83090,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.55,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,477,
"HYDROXYPROGESTERONE,17-AL",3083498,CDM,301,RC,83498,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.32,130,,,,,0,"fee schedule","130% of CMS fee schedule",41.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",42.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.45,351,
"HYDROXYPROLINE, TOTAL",3083505,CDM,301,RC,83500,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",34.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",421.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",421.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",23.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",35.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.39,675,
"IBUPROFEN LEVEL",3000158,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.86,125.18,,28.47,28.47,28.47,"1 through 10","fee schedule","125.18% of GA fee schedule",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,301.5,
IGA,3000159,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,166.5,
IGD,3000160,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,180,
IGE,3082785,CDM,301,RC,83520,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,243,
IGF-1,3084305,CDM,301,RC,84305,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.17,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.69,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.46,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.17,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.13,391.5,
IGG,3000161,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,166.5,
IGM,3000162,CDM,301,RC,82784,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.07,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",9.3,100,,9.11,9.11,9.11,"1 through 10","fee schedule","100% of CMS fee schedule",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.37,297,
"IMIPRAMIME  LEVEL",3080174,CDM,301,RC,80335,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.1,346.5,
"INSULIN 2 SPECIMENS",3000386,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,225,
"INSULIN 3 SPECIMENS",3000383,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,225,
"INSULIN 4 SPECIMENS",3000384,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,225,
"INSULIN 5 SPECIMENS",3000385,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,225,
"INSULIN LEVEL",3083525,CDM,301,RC,83525,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.29,225,
"IRON BINDING CAPACITY",3083550,CDM,301,RC,83550,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.76,125.18,,8.74,8.74,8.74,"1 through 10","fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.74,100,,8.57,8.57,8.57,12,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,247.5,
"IRON BINDING CAPACITY",3183550,CDM,301,RC,83550,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.76,125.18,,8.74,8.74,8.74,"1 through 10","fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.74,100,,8.57,8.57,8.57,12,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,247.5,
"IRON BINDING CAPACITY S",3080037,CDM,301,RC,83550,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.76,125.18,,8.74,8.74,8.74,"1 through 10","fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.74,100,,8.57,8.57,8.57,12,"fee schedule","100% of CMS fee schedule",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.87,247.5,
"IRON, SERUM",3083540,CDM,301,RC,83540,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.81,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.2,125.18,,6.47,6.47,6.47,"1 through 10","fee schedule","125.18% of GA fee schedule",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,6.34,6.34,6.34,13,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,112.5,
"IRON, SERUM S",3080016,CDM,301,RC,83540,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.81,120.37,,9.30,9.30,9.30,"1 through 10","fee schedule","120.37% of GA fee schedule",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.2,125.18,,6.47,6.47,6.47,"1 through 10","fee schedule","125.18% of GA fee schedule",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,6.34,6.34,6.34,13,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,112.5,
"I-STAT BUN",3000679,CDM,301,RC,84520,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.56,139.5,
"I-STAT CHLORIDE",3000678,CDM,301,RC,82435,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.69,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.14,135,
"I-STAT CREATININE",3000682,CDM,301,RC,82565,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,2.09,1.94,2.42,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,5.12,5.12,5.12,"1 through 10","fee schedule","120.37% of GA fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.61,139.5,
"I-STAT GLUCOSE",3000675,CDM,301,RC,82947,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.93,120.37,,5.63,5.63,5.63,"1 through 10","fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.17,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,4.91,4.91,4.91,"1 through 10","percent of total billed charges","68.7% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.54,135,
"I-STAT IONIZED CA++",3000680,CDM,301,RC,80047,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.37,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.36,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.36,139.5,
"I-STAT POTASSIUM",3000677,CDM,301,RC,84132,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.24,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.76,100,,4.66,4.66,4.66,"1 through 10","fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,135,
"I-STAT SODIUM",3000676,CDM,301,RC,84295,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.57,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.81,100,,4.71,4.71,4.71,"1 through 10","fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.33,135,
"I-STAT TCO2",3000681,CDM,301,RC,82374,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.34,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.39,126,
"L/D GLUCOSE STRIP/BEDSIDE",3082960,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,153,
"L/S RATIO",3083661,CDM,301,RC,83661,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.43,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.6,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.79,391.5,
"LACTIC ACID S",3183605,CDM,301,RC,83605,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.17,120.37,,11.84,9.94,14.99,"1 through 10","fee schedule","120.37% of GA fee schedule",171.41,56.2,,6.73,6.33,7.12,"1 through 10","percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,118.95,118.95,118.95,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.17,120.37,,11.57,11.57,11.57,"1 through 10","fee schedule","120.37% of GA fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,274.5,
"LASA (SIALIC ACID)",3084275,CDM,301,RC,84275,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.1,450,
LDH,3083615,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.44,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.44,198,
"LDH ISOENZYMES",3083625,CDM,301,RC,83625,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.63,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.05,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.51,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.51,297,
"LDH S",3080024,CDM,301,RC,83615,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.44,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.44,198,
"LEAD BLOOD",3083655,CDM,301,RC,83655,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.04,120.37,,11.41,11.41,11.41,"1 through 10","fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.52,125.18,,11.19,11.19,11.19,"1 through 10","fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,225,
"LEAD URINE 24 HOUR",3000186,CDM,301,RC,83655,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.04,120.37,,11.41,11.41,11.41,"1 through 10","fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.52,125.18,,11.19,11.19,11.19,"1 through 10","fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,225,
LEVETIRACETAM,3000187,CDM,301,RC,80177,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.52,102,,,,,0,"fee schedule","102% of CMS fee schedule",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,535.5,
"LH SERUM",3083002,CDM,301,RC,83002,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.08,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,342,
"LIPASE LEVEL",3083690,CDM,301,RC,83690,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.42,120.37,,8.76,7.86,9.66,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,2.72,2.72,2.92,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.84,125.18,,6.89,6.89,6.89,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.42,120.37,,6.89,6.89,6.89,"1 through 10","fee schedule","120.37% of GA fee schedule",6.89,100,,6.75,6.75,6.75,"1 through 10","fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,279,
"LIPASE LEVEL S",3080025,CDM,301,RC,83690,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.42,120.37,,8.76,7.86,9.66,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,2.72,2.72,2.92,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.84,125.18,,6.89,6.89,6.89,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.42,120.37,,6.89,6.89,6.89,"1 through 10","fee schedule","120.37% of GA fee schedule",6.89,100,,6.75,6.75,6.75,"1 through 10","fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,279,
"LIPASE,  PERITONEAL FLUID",3000554,CDM,301,RC,83690,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.42,120.37,,8.76,7.86,9.66,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,2.72,2.72,2.92,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.84,125.18,,6.89,6.89,6.89,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.42,120.37,,6.89,6.89,6.89,"1 through 10","fee schedule","120.37% of GA fee schedule",6.89,100,,6.75,6.75,6.75,"1 through 10","fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,279,
"LIPID OR HDL PROFILE",3080061,CDM,301,RC,80061,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.28,120.37,,19.23,19.23,19.23,"1 through 10","fee schedule","120.37% of GA fee schedule",230.42,56.2,,13.25,10.92,13.25,"1 through 10","percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.09,125.18,,13.39,13.39,13.39,"1 through 10","fee schedule","125.18% of GA fee schedule",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,90,,,,,0,"fee schedule","90% of CMS fee schedule",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.39,100,,13.12,13.12,13.12,39,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,369,
"LIPID OR HDL PROFILE S",3080058,CDM,301,RC,80061,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.28,120.37,,19.23,19.23,19.23,"1 through 10","fee schedule","120.37% of GA fee schedule",230.42,56.2,,13.25,10.92,13.25,"1 through 10","percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.09,125.18,,13.39,13.39,13.39,"1 through 10","fee schedule","125.18% of GA fee schedule",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,90,,,,,0,"fee schedule","90% of CMS fee schedule",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.39,100,,13.12,13.12,13.12,39,"fee schedule","100% of CMS fee schedule",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,369,
"LIPOMED (NMR)",3000188,CDM,301,RC,83704,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",47.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",34.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",47.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",34.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.77,387,
"LIPOPROTEIN (a)",3083695,CDM,301,RC,83695,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.89,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.89,342,
"LITHIUM LEVEL",3080178,CDM,301,RC,80178,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.95,184.5,
"MAGNESIUM LEVEL",3083735,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.14,120.37,,8.52,7.64,9.39,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,2.65,2.57,3.31,16,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,87.39,87.39,87.39,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.14,120.37,,6.70,6.70,6.70,13,"fee schedule","120.37% of GA fee schedule",6.7,100,,6.57,6.57,6.57,"1 through 10","fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,180,
"MAGNESIUM LEVEL S",3080026,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.14,120.37,,8.52,7.64,9.39,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,2.65,2.57,3.31,16,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,87.39,87.39,87.39,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.14,120.37,,6.70,6.70,6.70,13,"fee schedule","120.37% of GA fee schedule",6.7,100,,6.57,6.57,6.57,"1 through 10","fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,180,
"MAGNESIUM URINE W/CREATININE",3000190,CDM,301,RC,83735,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.14,120.37,,8.52,7.64,9.39,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.65,2.57,3.31,16,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,87.39,87.39,87.39,"1 through 10","percent of total billed charges","68.7% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.14,120.37,,6.70,6.70,6.70,13,"fee schedule","120.37% of GA fee schedule",6.7,100,,6.57,6.57,6.57,"1 through 10","fee schedule","100% of CMS fee schedule",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.03,153,
"MEPROBAMATE SERUM LEVEL",3083805,CDM,301,RC,80369,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.69,391.5,
"MERCURY 24 HOUR URINE",3083825,CDM,301,RC,83825,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.6,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.63,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.63,297,
"MERCURY BLOOD",3000193,CDM,301,RC,83825,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.6,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.63,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.63,180,
"METANEPHRINES 24 URINE",3083835,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,342,
"METANEPHRINES RANDON UA",3000371,CDM,301,RC,83835,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.25,342,
"METHANOL  BLOOD LEVEL",3084600,CDM,301,RC,80320,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.36,120.37,,14.74,14.74,14.74,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.36,288,
"METHOTREXATE, SERUM",3000197,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,288,
"MEXILETINE  LEVEL",3000199,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,342,
"MOLECULAR DGN AMP (APOE)",3000584,CDM,301,RC,83908,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MOLECULAR DGN AMP (C FG X",3000201,CDM,301,RC,81223,HCPCS,OUTPATIENT,,,315,252,,267.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",177.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",177.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",177.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",177.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",508.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",283.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1201.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",216.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",182.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",267.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",177.03,1201.73,
"MOLECULAR DGN ENZ",3000202,CDM,301,RC,83892,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"MOLECULAR DGN ENZ (C FG X",3000203,CDM,301,RC,83892,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DGN ENZYMATIC DIGESTION (APOE)",3000582,CDM,301,RC,83892,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MOLECULAR DGN I&R",3000575,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MOLECULAR DGN I&R (APOE)",3000585,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MOLECULAR DGN I&R (C FG X",3083912,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DGN ISOL OR EXT (APOE)",3000581,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MOLECULAR DGN NAP (APOE)",3000583,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MOLECULAR DGN NAP (C FG X",3083896,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DGN NAT (C FG X",3083897,CDM,301,RC,83897,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DGN SEP & ID",3093909,CDM,301,RC,83909,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"MOLECULAR DGN SEP (C FG X",3000205,CDM,301,RC,83894,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DIAG",3083890,CDM,301,RC,83890,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"MOLECULAR DIAG (C FRAG X)",3000206,CDM,301,RC,83890,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DIAG AMP OF PNA",3000576,CDM,301,RC,83900,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"MOLECULAR DIAG AMP OF PNA(HLA NAR)",3083900,CDM,301,RC,83900,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MOLECULAR DIAG AMP PNA,MU",3000573,CDM,301,RC,83901,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MOLECULAR DIAG AMP PNA,MU",3083901,CDM,301,RC,83901,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DIAG I&R (HLA NAR)",3000564,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MOLECULAR DIAG ISOL OR EXT PNA",3000574,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MOLECULAR DIAG ISOL OR EXT PNA (HLA NAR)",3000561,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MOLECULAR DIAG NAP (HLA NAR)",3000563,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MOLECULAR DIAG SEP & ID",3000577,CDM,301,RC,83909,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MOLECULAR DIAG SEP & ID (HLA NAR)",3083909,CDM,301,RC,83909,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MOLECULAR DIAG SEP BY GEL (HLA NAR)",3000562,CDM,301,RC,83894,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"MOLECULAR DIAG, AMP PNA,1",3000207,CDM,301,RC,81223,HCPCS,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",47.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",47.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",508.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1201.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.77,1201.73,
"MOLECULAR DIAG, AMP PNA,1",3000208,CDM,301,RC,81223,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",508.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",1201.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1155.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",499,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.64,1201.73,
"MOLECULAR DIAG, DOT",3083893,CDM,301,RC,83893,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"MOLECULAR DIAG, INTERPRET",3000209,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"MOLECULAR DIAG, INTERPRET",3000210,CDM,301,RC,83912,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"MOLECULAR DIAG, ISOLATION",3000211,CDM,301,RC,83890,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"MOLECULAR DIAG, MUT ID",3083904,CDM,301,RC,83904,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"MOLECULAR DIAG, MUT SCAN",3083903,CDM,301,RC,83903,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,463.5,
"MOLECULAR DIAG, NAP",3000212,CDM,301,RC,83896,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"MOLECULAR DIAG,AMP PNA",3000213,CDM,301,RC,83901,HCPCS,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"MOLECULAR DIAG,DOT/SLOT B",3000214,CDM,301,RC,83893,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MOLECULAR DIAG,ISO/E HPNA",3083891,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.1,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"MOLECULAR DIAG,ISO/EX PNA",3000215,CDM,301,RC,83891,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"MON GLUCOSE STRIP/BEDSIDE",3082959,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,153,
"MUCOPOLYSACCHARIDES URINE QUANT",3000216,CDM,301,RC,83864,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",29.07,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.26,243,
"MUTATION ID",3083914,CDM,301,RC,81355,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",86.67,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",89.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",90.13,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.67,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.05,114.66,
"MYELIN BASIC PROTEIN,CSF",3083873,CDM,301,RC,83873,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.54,102,,,,,0,"fee schedule","102% of CMS fee schedule",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.48,477,
"MYOGLOBIN SERUM",3083874,CDM,301,RC,83874,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.18,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.33,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.63,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.63,297,
"MYOGLOBIN URINE",3000220,CDM,301,RC,83874,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.18,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.33,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.63,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.63,297,
"MYSOLINE LEVEL",3080188,CDM,301,RC,80188,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.92,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.93,351,
"NIACIN LEVEL",3000223,CDM,301,RC,84591,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.18,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.35,90,,,,,0,"fee schedule","90% of CMS fee schedule",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.35,463.5,
NICOTINE,3080323,CDM,301,RC,80323,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",47.26,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.44,166.5,
"NORTRIPTYLINE LEVEL",3080182,CDM,301,RC,80335,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",27.1,351,
"NS2 GLUCOSE STRIP/BEDSIDE",3082957,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,153,
"N-TELOPEPTIDES (NTx) RANDOM URINE",3082523,CDM,301,RC,82523,HCPCS,OUTPATIENT,,,745,596,,633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.28,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",418.69,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",420.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.05,102,,,,,0,"fee schedule","102% of CMS fee schedule",670.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.42,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",511.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",432.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",633.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.81,670.5,
"OCCULT BLOOD  STOOL #1",3082270,CDM,301,RC,82270,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.86,120.37,,4.61,4.61,4.61,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,4.33,2.55,4.33,"1 through 10","percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.47,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.06,125.18,,4.38,4.38,4.38,"1 through 10","fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.38,100,,4.29,4.29,4.29,13,"fee schedule","100% of CMS fee schedule",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.94,126,
"OCCULT BLOOD-OTHER",3082271,CDM,301,RC,82271,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.86,120.37,,1.88,1.88,1.88,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.43,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.79,126,
"OLIGOCLONAL BANDS IgG (CSF)",3083916,CDM,301,RC,83916,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.61,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.43,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.94,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.65,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.43,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.65,387,
"ORGANIC ACID PROFIL,URINE",3083918,CDM,301,RC,83918,HCPCS,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.07,102,,,,,0,"fee schedule","102% of CMS fee schedule",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.24,1012.5,
"OSMOLALITY SERUM",3083930,CDM,301,RC,83930,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.95,184.5,
"OSMOLALITY STOOL",3084999,CDM,301,RC,84999,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"OSMOLALITY URINE",3083935,CDM,301,RC,83935,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.87,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.32,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.32,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,184.5,
"OSTEOCALCIN LEVEL",3083937,CDM,301,RC,83937,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",45.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",30.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.99,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.87,274.5,
"OXALIC ACID URINE",3083945,CDM,301,RC,83945,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,184.5,
"OXYCONTIN, QUANTITATIVE LEVEL",3000224,CDM,301,RC,80365,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"PANCREASTIN LEVEL",3000225,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",514.23,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",514.23,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,823.5,
"PARATHYROID HORMONE (PTH)",3083970,CDM,301,RC,83970,HCPCS,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",62.47,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",342.82,56.2,,40.86,40.86,40.86,"1 through 10","percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.47,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",41.28,100,,40.45,40.45,40.45,39,"fee schedule","100% of CMS fee schedule",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.15,549,
"PH  BODY FLUID LEVEL",3000204,CDM,301,RC,83986,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.22,126,
"PH STOOL",3083986,CDM,301,RC,83986,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.65,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.22,297,
"PHENOBARBITAL LEVEL",3080184,CDM,301,RC,80184,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.77,297,
"PHENYLALANINE PLASMA",3000639,CDM,301,RC,84030,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.95,243,
"PHOSOPOLIPIDS AB",3000649,CDM,301,RC,84311,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.29,90,
"PHOSPHORUS LEVEL",3084100,CDM,301,RC,84100,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.19,120.37,,4.21,4.21,4.21,"1 through 10","fee schedule","120.37% of GA fee schedule",87.11,56.2,,3.52,2.02,4.69,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.19,120.37,,4.74,4.74,4.74,"1 through 10","fee schedule","120.37% of GA fee schedule",4.74,100,,4.65,4.65,4.65,"1 through 10","fee schedule","100% of CMS fee schedule",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,139.5,
"PHOSPHORUS LEVEL S",3080028,CDM,301,RC,84100,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.19,120.37,,4.21,4.21,4.21,"1 through 10","fee schedule","120.37% of GA fee schedule",87.11,56.2,,3.52,2.02,4.69,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.83,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.19,120.37,,4.74,4.74,4.74,"1 through 10","fee schedule","120.37% of GA fee schedule",4.74,100,,4.65,4.65,4.65,"1 through 10","fee schedule","100% of CMS fee schedule",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,139.5,
"PHOSPHORUS URINE",3084105,CDM,301,RC,84105,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,139.5,
"PORPHOBILINOGEN RANDOM URINE",3084110,CDM,301,RC,84110,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.6,405,
"POSITIVE HCV",3000734,CDM,301,RC,87522,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",64.84,120.37,,42.84,42.84,42.84,"1 through 10","fee schedule","120.37% of GA fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,180,
"POTASSIUM SERUM",3084132,CDM,301,RC,84132,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.24,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.76,100,,4.66,4.66,4.66,"1 through 10","fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,135,
"POTASSIUM SERUM S",3080023,CDM,301,RC,84132,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.24,125.18,,6.35,6.35,6.35,"1 through 10","fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.76,100,,4.66,4.66,4.66,"1 through 10","fee schedule","100% of CMS fee schedule",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.28,135,
"POTASSIUM URINE SPOT",3084133,CDM,301,RC,84133,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.26,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.26,135,
"POTASSIUM URINE SPOT S",3080043,CDM,301,RC,84133,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.26,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.26,135,
PRE-ALBUMIN,3084134,CDM,301,RC,84134,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.88,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.96,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.13,256.5,
"PREGNANCY SERUM (QUAL)",3000344,CDM,301,RC,84703,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.71,120.37,,8.16,7.32,9.00,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.67,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.1,125.18,,7.52,7.52,7.52,"1 through 10","fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.77,180,
"PREGNANCY URINE (QUAL)",3084703,CDM,301,RC,81025,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.58,120.37,,8.05,6.03,9.27,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,5.17,5.17,5.17,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.78,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.96,125.18,,8.61,8.61,8.61,"1 through 10","fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.75,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.58,120.37,,8.61,8.61,8.61,"1 through 10","fee schedule","120.37% of GA fee schedule",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.75,180,
"PROCAINAMIDE LEVEL",3080190,CDM,301,RC,80192,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.09,102,,,,,0,"fee schedule","102% of CMS fee schedule",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,90,,,,,0,"fee schedule","90% of CMS fee schedule",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,301.5,
PROCALCITONIN,3084145,CDM,301,RC,84145,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.39,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.5,387,
"PROGESTERONE LEVEL",3084144,CDM,301,RC,84144,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.83,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.83,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.77,342,
"PROGESTERONE RECEPTOR",3084233,CDM,301,RC,84233,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.24,130,,,,,0,"fee schedule","130% of CMS fee schedule",97.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",89.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.09,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.09,508.5,
"PROINSULIN LEVEL",3084206,CDM,301,RC,84206,HCPCS,OUTPATIENT,,,540,432,,459,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.7,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",303.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",303.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",370.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.02,90,,,,,0,"fee schedule","90% of CMS fee schedule",313.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",459,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.02,486,
"PROLACTIN LEVEL",3084146,CDM,301,RC,84146,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.44,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.44,382.5,
"PROLIXIN LVL/FLUPHENAZINE",3000238,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,535.5,
"PRONESTYL LEVEL",3080192,CDM,301,RC,80192,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.09,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,342,
"PROPOXYPHENE (DARVON) LEVEL",3000239,CDM,301,RC,80367,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",133.42,589.5,
"PROTEIN CSF",3084157,CDM,301,RC,84157,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.6,126,
"PROTEIN ELEC (24H URINE)",3000572,CDM,301,RC,84165,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.26,120.37,,15.42,15.42,15.42,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.74,100,,10.53,10.53,10.53,"1 through 10","fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,279,
"PROTEIN TOTAL SERUM",3084155,CDM,301,RC,84155,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,5.26,5.26,5.26,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.67,100,,3.60,3.60,3.60,"1 through 10","fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,126,
"PROTEIN TOTAL SERUM S",3080033,CDM,301,RC,84155,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,5.26,5.26,5.26,"1 through 10","fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.67,100,,3.60,3.60,3.60,"1 through 10","fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,126,
"PROTEIN URINE",3084156,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,3.64,3.64,3.64,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,3.67,3.67,3.67,"1 through 10","fee schedule","120.37% of GA fee schedule",3.67,100,,3.60,3.60,3.60,42,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,139.5,
"PROTEIN URINE S",3080044,CDM,301,RC,84156,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,3.64,3.64,3.64,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,3.67,3.67,3.67,"1 through 10","fee schedule","120.37% of GA fee schedule",3.67,100,,3.60,3.60,3.60,42,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,139.5,
"PROTIME WITH INR",3000360,CDM,301,RC,85610,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.95,120.37,,5.09,4.51,5.67,"1 through 10","fee schedule","120.37% of GA fee schedule",101.16,56.2,,2.62,2.39,2.85,"1 through 10","percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.18,125.18,,4.29,4.29,4.29,"1 through 10","fee schedule","125.18% of GA fee schedule",123.66,68.7,,121.32,121.32,121.32,"1 through 10","percent of total billed charges","68.7% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.86,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.95,120.37,,4.29,4.29,4.29,"1 through 10","fee schedule","120.37% of GA fee schedule",4.29,100,,4.20,4.20,4.20,"1 through 10","fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.86,162,
"PROTOPORPHYRIN FREE RBC",3084202,CDM,301,RC,84202,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.92,243,
"PROZAC (FLUOXETINE)",3000244,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",342.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,549,
"PSA (PROSTATE SPECIFIC AG LEVEL",3084153,CDM,301,RC,84153,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,18.20,18.20,18.20,"1 through 10","percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.39,100,,18.02,18.02,18.02,"1 through 10","fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.55,387,
"PSA FREE AND TOTAL(PSA 2)",3084154,CDM,301,RC,84154,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.55,198,
"PTH INTRAOPERATIVE",3000246,CDM,301,RC,83970,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",62.47,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,40.86,40.86,40.86,"1 through 10","percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.47,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",41.28,100,,40.45,40.45,40.45,39,"fee schedule","100% of CMS fee schedule",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.15,490.5,
PYRUVATE,3084210,CDM,301,RC,84210,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.43,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.43,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.03,630,
"QUANTIFERON TB GOLD",3086480,CDM,301,RC,86480,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",93.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",97.55,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",61.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",93.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",61.98,100,,60.74,60.74,60.74,"1 through 10","fee schedule","100% of CMS fee schedule",61.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.78,342,
"QUINIDINE LEVEL",3080194,CDM,301,RC,80194,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.09,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.14,256.5,
"RBC FOLATE",3000135,CDM,301,RC,82747,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.95,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",143.31,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18,102,,,,,0,"fee schedule","102% of CMS fee schedule",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.26,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,90,,,,,0,"fee schedule","90% of CMS fee schedule",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,229.5,
"RBC FOLATE",3082747,CDM,301,RC,85014,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.08,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.13,288,
"REC GLUCOSE STRIP/BEDSIDE",3082961,CDM,301,RC,82948,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,3.52,3.52,3.52,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,2.72,2.48,2.96,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,4.46,4.46,4.46,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,4.46,4.46,4.46,"1 through 10","fee schedule","120.37% of GA fee schedule",5.04,100,,4.94,4.94,4.94,"1 through 10","fee schedule","100% of CMS fee schedule",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.54,153,
"REFLEX LACTIC ACID",3283605,CDM,301,RC,83605,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.17,120.37,,11.84,9.94,14.99,"1 through 10","fee schedule","120.37% of GA fee schedule",171.41,56.2,,6.73,6.33,7.12,"1 through 10","percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,118.95,118.95,118.95,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.17,120.37,,11.57,11.57,11.57,"1 through 10","fee schedule","120.37% of GA fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,274.5,
"RENAL FUNCTION PANEL",3080069,CDM,301,RC,80069,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.28,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,8.59,8.59,8.59,"1 through 10","percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.67,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.68,100,,8.51,8.51,8.51,40,"fee schedule","100% of CMS fee schedule",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.81,450,
"RENAL FUNCTION PANEL S",3180069,CDM,301,RC,80069,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.28,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,8.59,8.59,8.59,"1 through 10","percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.67,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.68,100,,8.51,8.51,8.51,40,"fee schedule","100% of CMS fee schedule",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.81,450,
"RENIN LEVEL",3084244,CDM,301,RC,84244,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.43,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.79,382.5,
"REVERSE T3",3084482,CDM,301,RC,84482,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,112.5,
"RI ANTIBODIES",3000259,CDM,301,RC,84182,HCPCS,OUTPATIENT,,,1100,880,,935,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",618.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",618.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",29.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",755.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",638,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",935,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.29,990,
"RIBOFLAVIN (VITAMIN B-2)",3000260,CDM,301,RC,84252,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",376.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",376.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.22,603,
"RISPERIDONE LEVEL",3000263,CDM,301,RC,80342,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.57,508.5,
"RITALIN LEVEL",3000265,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",261.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,418.5,
"RITUXAN LEVEL",3086356,CDM,301,RC,86356,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",39.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",41.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.1,351,
"ROHIPNOL LEVEL",3000269,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,706.5,
"RT LACTIC ACID",3083605,CDM,301,RC,83605,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.17,120.37,,11.84,9.94,14.99,"1 through 10","fee schedule","120.37% of GA fee schedule",171.41,56.2,,6.73,6.33,7.12,"1 through 10","percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,118.95,118.95,118.95,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.17,120.37,,11.57,11.57,11.57,"1 through 10","fee schedule","120.37% of GA fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,274.5,
"RT REFLEX LACTIC ACID",5583605,CDM,301,RC,83605,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.17,120.37,,11.84,9.94,14.99,"1 through 10","fee schedule","120.37% of GA fee schedule",171.41,56.2,,6.73,6.33,7.12,"1 through 10","percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,118.95,118.95,118.95,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.17,120.37,,11.57,11.57,11.57,"1 through 10","fee schedule","120.37% of GA fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,274.5,
"SALICYLATE (SERUM TEST)",3080196,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.86,125.18,,28.47,28.47,28.47,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,382.5,
"SALICYLATE (SERUM TEST) S",3080030,CDM,301,RC,80329,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",106.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.86,125.18,,28.47,28.47,28.47,"1 through 10","fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.63,382.5,
"SELENIUM LEVEL",3084255,CDM,301,RC,84255,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.98,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.98,135,
"SEROQUEL LEVEL",3000279,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,535.5,
"SEROTONIN, SERUM",3084260,CDM,301,RC,84260,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",46.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",31.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",48.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.88,90,,,,,0,"fee schedule","90% of CMS fee schedule",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.88,589.5,
"SEROTONIN, WHOLE BLOOD",3000280,CDM,301,RC,84260,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",46.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",31.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",48.76,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.88,90,,,,,0,"fee schedule","90% of CMS fee schedule",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",30.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.88,589.5,
SGOT,3000281,CDM,301,RC,84450,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,166.5,
"SGOT S",3080006,CDM,301,RC,84450,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,166.5,
SGPT,3000282,CDM,301,RC,84460,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.41,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,166.5,
"SGPT S",3080004,CDM,301,RC,84460,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.41,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,166.5,
"SODIUM FECES",3084302,CDM,301,RC,84302,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.32,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.37,135,
"SODIUM SERUM",3084295,CDM,301,RC,84295,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.57,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.81,100,,4.71,4.71,4.71,"1 through 10","fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.33,135,
"SODIUM SERUM S",3080027,CDM,301,RC,84295,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.57,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.81,100,,4.71,4.71,4.71,"1 through 10","fee schedule","100% of CMS fee schedule",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.33,135,
"SODIUM URINE SPOT",3084300,CDM,301,RC,84300,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.24,120.37,,4.87,4.87,4.87,"1 through 10","fee schedule","120.37% of GA fee schedule",5.06,100,,4.96,4.96,4.96,"1 through 10","fee schedule","100% of CMS fee schedule",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.55,135,
"SODIUM URINE SPOT S",3080045,CDM,301,RC,84300,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.24,120.37,,4.87,4.87,4.87,"1 through 10","fee schedule","120.37% of GA fee schedule",5.06,100,,4.96,4.96,4.96,"1 through 10","fee schedule","100% of CMS fee schedule",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.55,135,
SOMATOSTATIN,3084307,CDM,301,RC,84307,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.76,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.67,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",502.99,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.99,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.67,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.45,805.5,
"STONE ANALYSIS",3000291,CDM,301,RC,82365,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,279,
"SULFONYLUREA, SERUM",3084392,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,508.5,
"SULFONYLUREA, URINE",3000293,CDM,301,RC,82486,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",317.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",115.09,508.5,
"T 3 UPTAKE OR T UPTAKE",3084479,CDM,301,RC,84479,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,6.34,6.34,6.34,"1 through 10","fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,139.5,
"T4 OR TOTAL T4",3084436,CDM,301,RC,84436,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",73.06,56.2,,2.89,2.89,2.89,"1 through 10","percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.83,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.41,120.37,,6.87,6.87,6.87,"1 through 10","fee schedule","120.37% of GA fee schedule",6.87,100,,6.73,6.73,6.73,"1 through 10","fee schedule","100% of CMS fee schedule",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.18,117,
"TESTOSTERONE LEVEL",3084403,CDM,301,RC,84403,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",39.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.65,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.23,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.81,100,,25.29,25.29,25.29,"1 through 10","fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.23,297,
"TESTOSTERONE TOTAL LEVEL",3000298,CDM,301,RC,84403,HCPCS,OUTPATIENT,,,365,292,,310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",39.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",205.13,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",205.13,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",328.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.65,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",250.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.23,90,,,,,0,"fee schedule","90% of CMS fee schedule",211.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.81,100,,25.29,25.29,25.29,"1 through 10","fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.23,328.5,
"THEOPHYLLINE LEVEL",3080198,CDM,301,RC,80198,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.38,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.73,279,
"THIAMINE LEVEL",3084425,CDM,301,RC,84425,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.42,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.11,297,
"THIORIDAZINE LEVEL",3000299,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,324,
"THIOTHIXENE LEVEL",3000300,CDM,301,RC,80307,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.78,130,,,,,0,"fee schedule","130% of CMS fee schedule",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",63.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",76.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.93,324,
"THYROTROPIN RECPTOR AB",3000595,CDM,301,RC,83519,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,342,
TIAGABINE,3000118,CDM,301,RC,80199,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.24,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.65,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.4,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,432,
"TOBRAMYCIN LEVEL",3080200,CDM,301,RC,80200,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.58,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.52,297,
"TOTAL T3 OR T3",3084480,CDM,301,RC,84480,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.46,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,225,
"TRANSFERRIN LEVEL",3084466,CDM,301,RC,84466,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.33,120.37,,18.33,18.33,18.33,"1 through 10","fee schedule","120.37% of GA fee schedule",123.64,56.2,,12.63,12.63,12.63,"1 through 10","percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.02,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.48,198,
"TRANSFERRIN LEVEL S",3080034,CDM,301,RC,84466,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.33,120.37,,18.33,18.33,18.33,"1 through 10","fee schedule","120.37% of GA fee schedule",123.64,56.2,,12.63,12.63,12.63,"1 through 10","percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.02,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.48,198,
"TRANSGLUTAMINASE TISSUE IgA",3000017,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,612,
"TRANSGLUTAMINASE TISSUE IgG",3000018,CDM,301,RC,83516,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,612,
"TRAZODONE LEVEL",3000310,CDM,301,RC,80338,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",97.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",79.44,351,
"TRIGLYCERIDES LEVEL",3084478,CDM,301,RC,84478,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.46,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.17,166.5,
"TRIGLYCERIDES LEVEL S",3080032,CDM,301,RC,84478,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.46,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.17,166.5,
TRILEPTAL,3000311,CDM,301,RC,80299,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,387,
"TROPONIN HIGH SENSITIVITY",3000683,CDM,301,RC,84484,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.9,120.37,,14.13,11.55,14.46,"1 through 10","fee schedule","120.37% of GA fee schedule",171.41,56.2,,3.99,3.59,4.59,"1 through 10","percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.72,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.5,125.18,,12.47,12.47,12.47,"1 through 10","fee schedule","125.18% of GA fee schedule",209.54,68.7,,118.95,118.95,118.95,"1 through 10","percent of total billed charges","68.7% of total billed charges",12.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.9,120.37,,12.47,12.47,12.47,11,"fee schedule","120.37% of GA fee schedule",12.47,100,,12.22,12.22,12.22,"1 through 10","fee schedule","100% of CMS fee schedule",12.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.22,274.5,
TSH,3084443,CDM,301,RC,84443,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.84,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.42,120.37,,21.36,19.16,23.55,"1 through 10","fee schedule","120.37% of GA fee schedule",151.74,56.2,,9.96,9.46,16.63,"1 through 10","percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.44,125.18,,16.80,16.80,16.80,"1 through 10","fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.12,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.42,120.37,,16.80,16.80,16.80,"1 through 10","fee schedule","120.37% of GA fee schedule",16.8,100,,16.46,16.46,16.46,22,"fee schedule","100% of CMS fee schedule",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.12,243,
"UREA CLEARANCE",3084545,CDM,301,RC,84545,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",10,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.34,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.4,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",10,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.48,202.5,
"URIC ACID SERUM",3084550,CDM,301,RC,84550,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,10.26,5.64,14.88,"1 through 10","percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.84,120.37,,4.52,4.52,4.52,"1 through 10","fee schedule","120.37% of GA fee schedule",4.52,100,,4.43,4.43,4.43,15,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.07,184.5,
"URIC ACID SERUM S",3080035,CDM,301,RC,84550,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,10.26,5.64,14.88,"1 through 10","percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.84,120.37,,4.52,4.52,4.52,"1 through 10","fee schedule","120.37% of GA fee schedule",4.52,100,,4.43,4.43,4.43,15,"fee schedule","100% of CMS fee schedule",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.07,184.5,
"URIC ACID SYNOVIAL FLUID",3000570,CDM,301,RC,84560,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.18,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.57,139.5,
"URIC ACID URINE",3084560,CDM,301,RC,84560,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.18,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.57,139.5,
"URINALYSIS PORPHYRINS",3084120,CDM,301,RC,84120,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,243,
"URINE FOR WATSON SCHWARTZ",3000326,CDM,301,RC,84110,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.6,342,
"VALIUM LEVEL",3000328,CDM,301,RC,80346,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28,274.5,
"VALPROIC ACID LEVEL",3080164,CDM,301,RC,80164,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,297,
"VALPROIC ACID LEVEL S",3080036,CDM,301,RC,80164,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,297,
"VANCOMYCIN LEVEL",3080202,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,342,
"VANCOMYCIN LEVEL S",3080046,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,342,
"VANCOMYCIN PEAK",3080203,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,342,
"VANCOMYCIN PEAK S",3080047,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,342,
"VANCOMYCIN TROUGH",3080204,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,342,
"VANCOMYCIN TROUGH S",3080049,CDM,301,RC,80202,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.54,100,,13.27,13.27,13.27,"1 through 10","fee schedule","100% of CMS fee schedule",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.19,342,
"VASOACTIVE INTESTINAL PREP",3084586,CDM,301,RC,84586,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",53.48,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",53.48,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.8,432,
"VBG (VENOUS BLOOD GAS)",5582804,CDM,301,RC,82803,HCPCS,OUTPATIENT,,,490,392,,416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.3,120.37,,21.45,21.45,21.45,"1 through 10","fee schedule","120.37% of GA fee schedule",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",275.38,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",441,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.47,125.18,,26.07,26.07,26.07,"1 through 10","fee schedule","125.18% of GA fee schedule",336.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",284.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.3,120.37,,26.07,26.07,26.07,"1 through 10","fee schedule","120.37% of GA fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,441,
"VITAMIN A  LEVEL",3084590,CDM,301,RC,84590,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.45,369,
"VITAMIN B6",3084207,CDM,301,RC,84207,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",42.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",28.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",44.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.29,207,
"VITAMIN C LEVEL",3082180,CDM,301,RC,82180,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.09,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.9,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.9,202.5,
"VITAMIN D (1,25 Di) D2",3082652,CDM,301,RC,82652,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",58.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",39.27,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.65,432,
"VITAMIN D (25-HYDROXY) TOTAL LEVEL",3082306,CDM,301,RC,82306,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",44.8,120.37,,42.47,42.47,42.47,"1 through 10","fee schedule","120.37% of GA fee schedule",289.43,56.2,,29.30,29.30,29.30,"1 through 10","percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",30.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.6,100,,29.01,29.01,29.01,22,"fee schedule","100% of CMS fee schedule",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.64,463.5,
"VITAMIN E LEVEL",3084446,CDM,301,RC,84446,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.43,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.46,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.32,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.76,256.5,
"VMA RANDOM URINE",3084585,CDM,301,RC,84585,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.4,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.95,297,
"YO ANTIBODIES",3000337,CDM,301,RC,84182,HCPCS,OUTPATIENT,,,1100,880,,935,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",618.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",618.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",29.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",755.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",638,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",935,85,,,,,0,"percent of total billed charges","85% of total billed charges",29.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.29,990,
"ZINC LEVEL",3084630,CDM,301,RC,84630,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.93,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.25,202.5,
"ZOLOFT LEVEL",3000338,CDM,301,RC,80332,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",168,35,,,,,0,"percent of total billed charges","35% of total billed charges",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",97.78,432,
"ZYPREXA  LEVEL",3000340,CDM,301,RC,80342,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",163.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.57,589.5,
.ALDOSTERONE,3000671,CDM,302,RC,82088,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",61.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",41.57,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.68,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",40.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.68,166.5,
".ANTI ACETYLCHOLINE RECPT",3000348,CDM,302,RC,83519,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.56,432,
".ASO (STREPTOZYME) (EFCH)",3000809,CDM,302,RC,86060,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.3,100,,7.15,7.15,7.15,"1 through 10","fee schedule","100% of CMS fee schedule",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.57,166.5,
".ASO W/(ARTHRITIS PROFILE)",3000025,CDM,302,RC,86063,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.19,94.5,
".BARTONELLA HENSELAE IgG",3086611,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,346.5,
".BARTONELLA HENSELAE IgM",3000640,CDM,302,RC,86611,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,346.5,
".CANDIDA DNA AMP PROBE",3087481,CDM,302,RC,87481,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,94.5,
".DETECT AGENT DNA PROBE",87798,CDM,302,RC,87798,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,94.5,
".DETECT AGENT DNA PROBE",3087789,CDM,302,RC,87798,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,94.5,
".EBV (EB VIRUS)",3086664,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.08,125.18,,15.29,15.29,15.29,"1 through 10","fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,166.5,
".EHRLICH.TIT IgG(CHAFF/EQU",3086666,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,279,
".EHRLICH.TIT IgM(CHAFF/EQU",3000095,CDM,302,RC,86666,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,279,
".EJ AUTOABS",3000621,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,103.5,
".ENTEROVIRUS(COXSACKIE A)",3086658,CDM,302,RC,86658,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.94,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.5,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.73,126,
".FLUORESCENT NONINF TITER",3000114,CDM,302,RC,86256,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,166.5,
".GEL DIFFUSION, EACH",3086331,CDM,302,RC,86331,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,180,
.HISTONE,3000364,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,180,
".IMMUNOFIX ELEC (SPEP W IM",3000166,CDM,302,RC,86334,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",35.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.11,202.5,
".INHIBIN A",3086336,CDM,302,RC,86336,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.03,225,
.KAPPA/LAMBA,3000732,CDM,302,RC,83883,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.24,103.5,
".KU AUTOABS",3000620,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,103.5,
".LYME IGG",3000728,CDM,302,RC,86617,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.39,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,94.5,
".LYME IGM",3000729,CDM,302,RC,86617,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.39,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,94.5,
".MI-2 AUTOABS",3000619,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,103.5,
".PARVOVIRUS PANEL IGM",3000226,CDM,302,RC,86747,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.54,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.53,139.5,
".PL-12 AUTOABS",3000618,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,103.5,
".PL-7 AUTOABS",3000617,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,103.5,
".RA TEST (EFCH)",3000808,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.94,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.53,180,
".RA W/(ARTHRITIS PROFILE)",3000248,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.94,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.53,81,
".RAST FOR DOG EPITHELIUM",3000444,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
.RENIN,3000674,CDM,302,RC,84244,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.59,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.43,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.79,103.5,
".ROCKY MOUNT SPOT FEV IgG",3000267,CDM,302,RC,86757,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,162,
".ROCKY MOUNT SPOT FEV IgM",3000268,CDM,302,RC,86757,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,162,
.RUBELLA,3086762,CDM,302,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
".SS-A ANTIBODY (SJOGREN)",3000288,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,243,
".SSA/SSB (SJOGREN'S AB)",3000290,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,103.5,
".SS-B ANTIBODY (SJOGREN)",3000289,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,243,
".STAPH A DNA AMP PROBE",3087640,CDM,302,RC,87640,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,94.5,
".STREP B DNA AMP PROBE",3087653,CDM,302,RC,87653,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,94.5,
".THYROGLOBULIN AB",3007032,CDM,302,RC,86800,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.91,100,,15.59,15.59,15.59,"1 through 10","fee schedule","100% of CMS fee schedule",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,202.5,
".THYROGLOBULIN PANEL",3007033,CDM,302,RC,84432,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,202.5,
".VCA IgG/IgM (EB VIRUS)",3086665,CDM,302,RC,86665,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.47,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.57,125.18,,18.14,18.14,18.14,"1 through 10","fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.33,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.47,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.33,202.5,
"3RD 5' NUCLEOTIDASE",3083915,CDM,302,RC,83915,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.37,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.55,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,153,
"3RD ANTI GBM (GLOMERULAR B)",3086318,CDM,302,RC,83520,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.27,100,,16.92,16.92,16.92,"1 through 10","fee schedule","100% of CMS fee schedule",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.54,450,
"3RD ANTIMITOCHONDRIAL ANTIBOD",3000020,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,243,
"3RD C1-ESTERASE INHIBITOR",3086161,CDM,302,RC,86161,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,297,
"3RD CARDIOLIPIN ABS",3086147,CDM,302,RC,86147,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.96,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.91,153,
"3RD CMV QUANTATIVE BY PCR",3087497,CDM,302,RC,87497,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",42.84,100,,41.98,41.98,41.98,"1 through 10","fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,589.5,
"3RD CYTOMEGALOVIRUS IgG Ab",3086644,CDM,302,RC,86644,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,256.5,
"3RD CYTOMEGALOVIRUS IgM Ab",3000081,CDM,302,RC,86645,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",25.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.53,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,297,
"3RD HEP C ANTIBODY QUANT",3086803,CDM,302,RC,86803,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.56,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.04,256.5,
"3RD HEPATITIS C BY RNA",3086804,CDM,302,RC,87522,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",64.84,120.37,,42.84,42.84,42.84,"1 through 10","fee schedule","120.37% of GA fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,342,
"3RD HEPATITIS DELTA VIRSUS AB",3086692,CDM,302,RC,87799,HCPCS,OUTPATIENT,,,1155,924,,981.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",235.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",649.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",652.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",649.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",652.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",1039.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",404.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",793.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",669.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",235.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",981.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,1039.5,
"3RD HISTONE AB",3000012,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,297,
"3RD INSULIN ANTIBODIES",3086337,CDM,302,RC,86337,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.83,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.27,387,
"3RD ISLET CELL IgG AUTOAB",3086341,CDM,302,RC,86341,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.04,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.21,351,
"3RD KAPPA/LAMBDA CHAINS URINE",3000165,CDM,302,RC,83883,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.24,351,
"3RD LIGHT CHAINS-SERUM IEP",3083883,CDM,302,RC,83883,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.24,351,
"3RD LIGHT CHAINS-UA IEP",3000327,CDM,302,RC,86334,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",35.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.34,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.11,351,
"3RD PREGNENOLONE",3084140,CDM,302,RC,84140,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.87,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.55,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.6,202.5,
"3RD RA TEST BODY FLUID",3086431,CDM,302,RC,86430,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.98,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.94,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.53,180,
"3RD RAST FOR EGG WHOLE",3000447,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"3RD TETANUS ANTIBODIES",3086774,CDM,302,RC,86774,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.24,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.3,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.32,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.32,297,
"3RD TOXOPLASMOSIS IgG",3086777,CDM,302,RC,86777,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,243,
"3RD TOXOPLASMOSIS IgM",3086778,CDM,302,RC,86778,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.67,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.97,324,
"3RD WEST NILE IGG VIRUS (CSF)",3000333,CDM,302,RC,86789,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,450,
"3RD WEST NILE IGG VIRUS(SERUM)",3000334,CDM,302,RC,86789,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,450,
"3RD WEST NILE IGM VIRUS (CSF)",3000548,CDM,302,RC,86789,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,450,
"3RD WEST NILE VIRUS ABS(SERUM)",3000547,CDM,302,RC,86789,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,450,
"ABSOLUTE CD4,CD8&CD19",3086360,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.07,130,,,,,0,"fee schedule","130% of CMS fee schedule",71.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",47.92,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",46.98,100,,46.04,46.04,46.04,"1 through 10","fee schedule","100% of CMS fee schedule",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,450,
"AMOEBIC ANTIBODIES",3086753,CDM,302,RC,86753,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,279,
"AMOXICILLIN IGE",3000668,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,153,
"AMPICILLIN IGE",3000669,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,153,
"ANA  W/TITER",3086039,CDM,302,RC,86038,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.72,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.3,120.37,,17.34,17.34,17.34,"1 through 10","fee schedule","120.37% of GA fee schedule",151.74,56.2,,11.97,11.97,11.97,"1 through 10","percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.03,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.88,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.09,100,,11.85,11.85,11.85,"1 through 10","fee schedule","100% of CMS fee schedule",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.88,243,
ANCA,3086021,CDM,302,RC,86038,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.72,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.3,120.37,,17.34,17.34,17.34,"1 through 10","fee schedule","120.37% of GA fee schedule",244.47,56.2,,11.97,11.97,11.97,"1 through 10","percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.03,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.88,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.09,100,,11.85,11.85,11.85,"1 through 10","fee schedule","100% of CMS fee schedule",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.88,391.5,
"ANTI DIURETIC HORMONE",3084588,CDM,302,RC,84588,HCPCS,OUTPATIENT,,,235,188,,199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",51.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",132.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",34.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",53.44,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",161.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",136.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,211.5,
"ANTI DNA DOUBLE STRANDED AB",3086225,CDM,302,RC,86225,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.74,100,,13.47,13.47,13.47,"1 through 10","fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.37,256.5,
"ANTI DNA SINGLE STRANDED",3086226,CDM,302,RC,86226,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.9,256.5,
"ANTI DNASE B",3086215,CDM,302,RC,86215,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.52,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.93,243,
"ANTI La",3000014,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,153,
"ANTI LKM",3086376,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.1,324,
"ANTI RO",3000016,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,153,
"ANTIBODY ID,TITER, AND TYPING",3000593,CDM,302,RC,86900,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",4.51,120.37,,4.29,4.29,4.29,"1 through 10","fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.69,125.18,,2.99,2.99,2.99,"1 through 10","fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.51,120.37,,2.99,2.99,2.99,"1 through 10","fee schedule","120.37% of GA fee schedule",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4.51,202.5,
"ANTI-PARIETAL CELL",3000019,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,247.5,
ANTISMOOTH,3000021,CDM,302,RC,83516,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.19,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.53,100,,11.30,11.30,11.30,"1 through 10","fee schedule","100% of CMS fee schedule",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.38,256.5,
"ASO (STREPTOZYME)",3086063,CDM,302,RC,86060,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.3,100,,7.15,7.15,7.15,"1 through 10","fee schedule","100% of CMS fee schedule",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.57,166.5,
"ASPERGILLUS ANTIBODY SCREEN",3086606,CDM,302,RC,86606,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.05,100,,14.75,14.75,14.75,"1 through 10","fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,198,
"BACTERIAL ANTIGENS PANEL",3086403,CDM,302,RC,,,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",152.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",152.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",152.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",124.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",213.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",124.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",124.26,549,
"BLASTOMYCES ANTIBODIES",3086612,CDM,302,RC,86612,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.54,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.32,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.54,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,198,
"BRUCELLA ABORTUS AB",3086622,CDM,302,RC,86622,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.04,184.5,
"C REACTIVE PROTEIN (CRP)",3086140,CDM,302,RC,86140,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,6.59,5.91,7.26,"1 through 10","fee schedule","120.37% of GA fee schedule",87.11,56.2,,5.13,4.09,5.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,5.08,5.08,5.08,13,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,139.5,
"C REACTIVE PROTEIN (CRP) S",3080052,CDM,302,RC,86140,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,6.59,5.91,7.26,"1 through 10","fee schedule","120.37% of GA fee schedule",87.11,56.2,,5.13,4.09,5.13,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,5.08,5.08,5.08,13,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,139.5,
"C REACTIVE PRTN(ULTR SENS",3086141,CDM,302,RC,86141,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.84,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.66,432,
"C1Q BINDING ASSAY",3086332,CDM,302,RC,86332,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",36.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",24.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.37,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.93,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.93,490.5,
"C3 COMPLEMENT",3086160,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,297,
"C4 COMPLEMENT",3000035,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,297,
"C6 COMPLEMENT",3000624,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,184.5,
"C7 COMPLEMENT",3000625,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,184.5,
"C8 COMPLEMENT",3000626,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,184.5,
"C9 COMPLEMENT",3000627,CDM,302,RC,86160,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12,100,,11.76,11.76,11.76,"1 through 10","fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,184.5,
"CA 125 (OVARY)",3086304,CDM,302,RC,86304,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,342,
"CA 15-3 (BREAST)",3086300,CDM,302,RC,86300,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,20.39,20.39,20.39,"1 through 10","fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,324,
"CA 19-9 (COLON)",3086301,CDM,302,RC,86301,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,342,
"CA 27-29",3000036,CDM,302,RC,86300,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,20.39,20.39,20.39,"1 through 10","fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,351,
"CD-4/CD-8 COUNT ABSOLUTE",3000040,CDM,302,RC,86360,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.07,130,,,,,0,"fee schedule","130% of CMS fee schedule",71.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",47.92,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",46.98,100,,46.04,46.04,46.04,"1 through 10","fee schedule","100% of CMS fee schedule",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,450,
"CENTROMERE ANTIB",3000044,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,153,
"CH 50 COMPLEMENT",3086162,CDM,302,RC,86162,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.42,130,,,,,0,"fee schedule","130% of CMS fee schedule",30.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.73,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.29,297,
"CHLAMYDIA TRACHOMATIS IGG ABS",3000045,CDM,302,RC,86631,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.37,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.06,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.61,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.64,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.64,139.5,
"CHLAMYDIA TRACHOMATIS IGM ABS",3000046,CDM,302,RC,86632,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.93,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.99,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.41,139.5,
"COCCIDIOIDES ANTIBODIES",3086635,CDM,302,RC,86635,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,198,
"COLD AGGLUTININS",3086156,CDM,302,RC,86157,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.48,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.69,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.25,202.5,
"COXIELLA BURNETII IGM ABS",3086638,CDM,302,RC,86638,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.76,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.91,490.5,
"CRYPTOCOCCUS ANTIGEN(CSF)",3000063,CDM,302,RC,87449,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,7.55,7.19,7.90,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,279,
"DIPHTHERIA ANTIBODIES",3086648,CDM,302,RC,86648,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.51,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.69,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.69,324,
"DNA ANTIBODIES (dsDNA)",3000086,CDM,302,RC,86225,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.74,100,,13.47,13.47,13.47,"1 through 10","fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.37,256.5,
"DNA BY FARR ASSAY",3000087,CDM,302,RC,86225,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.86,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.63,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.37,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.74,100,,13.47,13.47,13.47,"1 through 10","fee schedule","100% of CMS fee schedule",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.37,324,
"EBV EARLY AG IGG(EB VIRUS)",3086663,CDM,302,RC,86663,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.65,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.81,135,
"EBV NUCLEAR AG IGG",3086662,CDM,302,RC,86664,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.08,125.18,,15.29,15.29,15.29,"1 through 10","fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.76,94.5,
"ENCEPH,CALIFORNIA IgG",3086651,CDM,302,RC,86651,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
"ENCEPH,CALIFORNIA IgM",3000097,CDM,302,RC,86651,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
"ENCEPH,E.EQUINE IgG",3086652,CDM,302,RC,86652,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
"ENCEPH,E.EQUINE IgM",3000098,CDM,302,RC,86652,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
"ENCEPH,ST. LOUIS IgG",3086653,CDM,302,RC,86653,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
"ENCEPH,ST. LOUIS IgM",3000099,CDM,302,RC,86653,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
"ENDOMYSIAL, IgA ANTIBODY",3000349,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,274.5,
"ENTAMOEBA HISTOLYTICA ANTIBODY IGG",3087336,CDM,302,RC,86753,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,256.5,
"FRANCISELLA TULAREMIA TITER",3086668,CDM,302,RC,87081,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,126,
FTA-ABS,3086781,CDM,302,RC,86780,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",13.24,100,,12.98,12.98,12.98,"1 through 10","fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,202.5,
"GIARDIA ANTIGEN STOOL",3086674,CDM,302,RC,87329,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,126,
"GIARDIA, IgG, IgM (SERUM)",3000124,CDM,302,RC,86674,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.16,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.25,256.5,
"H PYLORI IgA Ab (LABCORP)",3000707,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,243,
"H PYLORI IgG Ab (LABCORP)",3086677,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,243,
"H PYLORI IgM Ab (LAB CORP)",3000139,CDM,302,RC,86677,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.17,243,
"H PYLORI STOOL ANTIGEN",3087338,CDM,302,RC,87338,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.67,102,,,,,0,"fee schedule","102% of CMS fee schedule",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.65,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.77,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.38,100,,14.09,14.09,14.09,"1 through 10","fee schedule","100% of CMS fee schedule",14.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.94,526.5,
"HEP A  AB TOTAL",3086708,CDM,302,RC,86708,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.64,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.5,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.15,342,
"HEP A IgM AB",3086709,CDM,302,RC,86709,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.49,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.13,94.5,
"HEP B CORE IgM AB",3086705,CDM,302,RC,86705,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.53,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.77,100,,11.53,11.53,11.53,"1 through 10","fee schedule","100% of CMS fee schedule",11.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.59,103.5,
"HEP B SURFACE ANTIBODY",3086706,CDM,302,RC,86706,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.95,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.74,100,,10.53,10.53,10.53,"1 through 10","fee schedule","100% of CMS fee schedule",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.67,225,
"HEPATITIS B CORE AB,TOTAL",3086704,CDM,302,RC,86704,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,11.81,11.81,11.81,"1 through 10","fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,225,
"HEPATITIS BE ANTIBODY",3086707,CDM,302,RC,86707,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.41,225,
"HERPES AB TY II IgG",3086696,CDM,302,RC,86696,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,184.5,
"HERPES AB TY II IgM",3000008,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,184.5,
"HERPES AB TYP I IgG",3086695,CDM,302,RC,86695,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,184.5,
"HERPES AB TYP I IgM",3000147,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,184.5,
"HISTOPLASMA ANTIBODIES",3086698,CDM,302,RC,86698,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.07,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.67,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.41,198,
"HLA B-27 ANTIGEN",3086812,CDM,302,RC,86812,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",39.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.23,90,,,,,0,"fee schedule","90% of CMS fee schedule",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",25.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.23,391.5,
"IMMUNOFIXATION SERUM",3086334,CDM,302,RC,84155,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.55,120.37,,5.26,5.26,5.26,"1 through 10","fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.67,100,,3.60,3.60,3.60,"1 through 10","fee schedule","100% of CMS fee schedule",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,351,
"IMMUNOFIXATION URINE+UPEP",3000167,CDM,302,RC,84166,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.18,130,,,,,0,"fee schedule","130% of CMS fee schedule",27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.05,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.83,100,,17.47,17.47,17.47,"1 through 10","fee schedule","100% of CMS fee schedule",17.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.05,351,
"INFLUENZA A VIRUS AB",3086710,CDM,302,RC,86710,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.2,324,
"INFLUENZA B VIRUS AB",3000173,CDM,302,RC,86710,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.52,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.2,324,
"JO-1 ANTIBODY",3000177,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,180,
"LE PREP (ANA)",3000185,CDM,302,RC,86039,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.58,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.16,100,,10.94,10.94,10.94,"1 through 10","fee schedule","100% of CMS fee schedule",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,243,
"LEGIONELLA ANTIBODIES IgG",3086713,CDM,302,RC,86713,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.17,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.61,102,,,,,0,"fee schedule","102% of CMS fee schedule",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.77,90,,,,,0,"fee schedule","90% of CMS fee schedule",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.17,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.77,477,
"LEPTOSPIRA URINE PCR",3086720,CDM,302,RC,87798,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,279,
"LYME DISEASE IgG, IgM CSF",3086617,CDM,302,RC,86617,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.39,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.94,504,
"MEASLES IgG",3000274,CDM,302,RC,86765,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,243,
"MEASLES IgM Ab",3086765,CDM,302,RC,86765,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,243,
"MONO TEST",3086308,CDM,302,RC,86308,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,3.83,3.83,3.83,"1 through 10","percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.28,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.15,125.18,,5.18,5.18,5.18,"1 through 10","fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.66,166.5,
"MULLERIAN HORMONE ANTIBODY",3000696,CDM,302,RC,82397,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.71,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.71,202.5,
"MUMPS VIRUS IGG AB",3086735,CDM,302,RC,86735,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.31,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.75,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.75,342,
"MUMPS VIRUS IGM ANTIBODY",3000217,CDM,302,RC,86735,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.31,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.54,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.75,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.75,342,
"MYCOPLASMA PNEUMONIAE/IgG",3086738,CDM,302,RC,86738,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,225,
"MYCOPLASMA PNEUMONIAE/IgM",3000219,CDM,302,RC,86738,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,225,
"NEURON SPECIFIC ENOLASE",3000579,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,247.5,
"NOCARDIA ANTIBODY",3086744,CDM,302,RC,86744,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.31,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,247.5,
"OPIATES LEVEL",3083925,CDM,302,RC,80365,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"PARVOVIRUS B19 IGG & IGM ABS",3086747,CDM,302,RC,86747,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.54,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.33,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.66,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.53,225,
"PENICILLIN G IGE",3000347,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,153,
"PENICILLIN V IGE",3000228,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,153,
"PLATELET ANTIBODIES",3086022,CDM,302,RC,86022,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.53,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.53,342,
"PM-SCL 100 AB",3000396,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",188.27,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,301.5,
"POSITIVE ANA TITER",3000010,CDM,302,RC,86039,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.58,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.9,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.16,100,,10.94,10.94,10.94,"1 through 10","fee schedule","100% of CMS fee schedule",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,103.5,
"POSITIVE ANCA TITER",3000740,CDM,302,RC,86021,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.35,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.55,103.5,
"RA TEST",3086430,CDM,302,RC,86431,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.37,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.78,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.94,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.67,100,,5.56,5.56,5.56,"1 through 10","fee schedule","100% of CMS fee schedule",5.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.1,180,
"RABIES ANTIBODY",3000249,CDM,302,RC,86790,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,297,
"RAST EACH ALLERGEN",3000253,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ALDER TREE",3000398,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ALMOND",3000399,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ALPHA LACTA ALBUMIN",3000694,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ALTERNARIA TENUIS",3000400,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR APPLE",3000401,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ASPARAGUS",3000402,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ASPERGILLIS (FUMIGATUS)",3000715,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ASPERGILLIS (NIGER)",3000598,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR AVOCADO",3000403,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BAHIA GRASS",3000404,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BAKER'S YEAST",3000405,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BANANA",3000406,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BARLEY",3000407,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BEECH TREE",3000409,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BEEF",3000410,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BERMUDA GRASS",3000411,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BETA LACTOGLOBULIN",3000695,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BIRCH TREE",3000412,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BLUEBERRY",3000413,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BOTRYTIS",3000414,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BRAZIL NUT",3000415,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BREWER'S YEAST",3000416,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR BUCKWHEAT",3000417,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CABBAGE",3000418,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CANARY GRASS",3000419,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CARELESS WEED",3000420,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CARROT",3000421,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CASEIN",3000422,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CASHEW",3000666,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CAT DANDER",3000423,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CEDAR MT",3000424,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CELERY",3000425,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CEPHALOSPORIN IGE",3000722,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CEREAL GP",3000426,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CHEDDAR CHEESE",3000427,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CHICKEN MEAT",3000428,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CHILI PEPPER",3000429,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CHOCOLATE",3000430,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CLAM",3000431,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COCKLEBUR",3000432,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COCKROACH",3000433,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COCONUT",3000434,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COD FISH",3000435,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COFFEE",3000436,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CORN",3000437,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CORN POLLEN",3000438,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COTTONWOOD TREE",3000439,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR COW DANDER",3000440,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CRAB",3000441,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CRAYFISH",3000651,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR CUCUMBER",3000442,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR DANDELION",3000443,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR DOG DANDER",3000714,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR DUST MITE (DERMATOPHAGOIDES PTE",3000712,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR DUST MITE (FARINAE)",3000713,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR DUST MITE (HOUSE)",3000599,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR EGG WHITE",3000445,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR EGG YOLK",3000446,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ELM TREE",3000448,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ERYTHROMYCIN",3000723,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR EUCALYPTUS TREE",3000449,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR FEATHER MIX",3000450,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR FIRE ANT",3000459,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR GARLIC",3000451,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR GLUTEN",3000452,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR GOLDENROD",3000453,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR GREEN BEAN",3000408,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR GREEN PEA",3000454,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HAZELNUT(FOOD)",3000455,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HICKORY WHITE",3000692,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HONEYBEE",3000397,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HOPS",3000597,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HORSE DANDER",3000456,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HOUSE DUST(GREER)",3000457,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR HOUSE DUST(HOLLISTER STEIR)",3000458,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR JOHNSON GRASS",3000460,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR JUNE GRASS(KY BLUE)",3000461,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR KIWI FRUIT",3000462,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR LAMB'S QTR",3000463,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR LATEX",3000464,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR LETTUCE",3000465,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR LOBSTER",3000466,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MALT",3000467,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MANGO",3000468,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MAPLE TREE",3000469,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MEADOW FESCUE",3000470,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MELON",3000471,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MILK",3000472,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MOLD ALLERGEN GP",3000473,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MUCOR RACEMOSUS",3000725,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MUGWORT",3000474,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MULBERRY WHITE",3000475,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR MUSTARD",3000476,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR NUT MIX GP",3000477,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR OAK TREE",3000478,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR OAT",3000479,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR OLIVE TREE",3000480,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ONION",3000481,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ORANGE",3000482,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ORCHARD GRASS",3000483,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR OVALBUMIN",3000484,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR OVAMUCOID",3000485,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR OYSTER",3000486,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PAPAYA",3000487,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PAPER WASP",3000488,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PARSLEY",3000489,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PEACH",3000490,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PEANUT",3000491,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PECAN NUT",3000492,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PECAN TREE",3000493,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PENICILLIUM MOLD",3000596,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PEPPER BLACK",3000494,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PEPPER GREEN",3000495,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PERENNIAL RYE",3000496,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PINTO BEAN",3000498,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PISTACHIO NUT",3000499,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR PORK",3000500,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR POTATO",3000501,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR R. NIGRICANS",3000726,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RABBIT EPITHELIAL",3000654,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RAGWEED COMMON",3000502,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RAGWEED FALSE",3000503,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RAGWEED GAINT",3000504,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RAGWEED WESTERN",3000505,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RED TOP GRASS",3000506,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RICE",3000507,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ROUGH MARSH ELDER",3000508,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR ROUGH PIGWEED",3000509,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR RUSSIAN THISTLE",3000510,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SALAD ALLERGEN GRP",3000511,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SALMON",3000512,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SEAFOOD",3000514,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SESAME SEED",3000515,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SHEEP SORREL",3000516,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SHRIMP",3000517,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SOYBEAN",3000518,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR STINGING INSECT GROUP",3000519,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR STRAWBERRY",3000520,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SUNFLOWER SEED",3000521,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SWEET POTATO",3000522,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SWEET VERNAL GRASS",3000523,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR SYCAMORE TREE",3000524,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR TIMOTHY GRASS",3000525,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR TOMATOES",3000526,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR TROUT",3000527,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR TUNA",3000528,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR TURKEY MEAT",3000529,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR VEGETABLE GRP",3000530,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WALNUT TREE",3000532,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WALNUT, FOOD",3000531,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WHEAT",3000533,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WHEY",3000693,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WHITE ASH TREE",3000534,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WHITE BEAN",3000535,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WHITE FACE HORNET",3000536,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WHITE PINE",3000497,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WILLOW TREE",3000537,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR WORMWOOD",3000538,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR YELLOW HORNET",3000539,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RAST FOR YELLOW JACKET",3000540,CDM,302,RC,86003,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.7,126,
"RH ANTIBODY TITER",3000257,CDM,302,RC,86256,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,166.5,
"RICKETTSIA IgG",3086757,CDM,302,RC,86757,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,162,
"RICKETTSIA IgM",3000261,CDM,302,RC,86757,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.74,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",19.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,162,
"RPR OR STS",3086592,CDM,302,RC,86592,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.6,120.37,,4.10,4.10,4.10,"1 through 10","fee schedule","120.37% of GA fee schedule",84.3,56.2,,1.80,1.80,1.80,"1 through 10","percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.82,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.6,120.37,,2.97,2.97,2.97,"1 through 10","fee schedule","120.37% of GA fee schedule",4.27,100,,4.18,4.18,4.18,"1 through 10","fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,135,
"RSV ANTIBODY IgG",3086756,CDM,302,RC,86756,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.3,162,
"RSV ANTIBODY IgM",3000271,CDM,302,RC,86756,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.3,162,
"RUBELLA IGG",3000272,CDM,302,RC,86762,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,184.5,
"RUBELLA IGM ANTIBODY",3000273,CDM,302,RC,86762,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.71,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.68,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.95,184.5,
"RUBEOLA IgM",3000275,CDM,302,RC,86765,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,243,
"SCLERODERMA ANTIBODIES",3000278,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,207,
"SMITH ANTIBODY",3000749,CDM,302,RC,86235,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",95.54,56.2,,17.75,17.75,17.75,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.93,100,,17.57,17.57,17.57,"1 through 10","fee schedule","100% of CMS fee schedule",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.14,153,
"SPERM ANTIBODIES",3000287,CDM,302,RC,86255,HCPCS,OUTPATIENT,,,930,744,,790.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",522.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",525.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",522.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",525.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",837,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.98,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",638.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",539.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",790.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,837,
"SQUAMOUS CA ANTIGEN (SCA)",3086316,CDM,302,RC,86316,HCPCS,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",356.87,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",356.87,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,571.5,
"STREPTOCOCCUS PNEUMONIAE  ANTIGENS URINE",3000628,CDM,302,RC,87899,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.39,102,,,,,0,"fee schedule","102% of CMS fee schedule",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.46,706.5,
"T CELLS COUNT",3000294,CDM,302,RC,86359,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",35.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",38.48,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.96,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.96,297,
"THYROGLOBULIN AB",3086800,CDM,302,RC,86800,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.07,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.91,100,,15.59,15.59,15.59,"1 through 10","fee schedule","100% of CMS fee schedule",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.32,202.5,
"THYROGLOBULIN PANEL",3084432,CDM,302,RC,84432,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",24.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",25.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.45,202.5,
"THYROGLOBULIN QUANT AB",3007034,CDM,302,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"THYROID MICROSOMAL AB",3000302,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.1,243,
"THYROID PEROXIDASE AB",3000303,CDM,302,RC,86376,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",22.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.91,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.1,243,
"TOXOCARA TITER",3086682,CDM,302,RC,86682,HCPCS,OUTPATIENT,,,825,660,,701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.91,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",463.65,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.65,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.27,102,,,,,0,"fee schedule","102% of CMS fee schedule",742.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",566.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.71,90,,,,,0,"fee schedule","90% of CMS fee schedule",478.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.68,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.71,742.5,
"TREPONEMA PALLIDIUM AB IgG,IgM",3000200,CDM,302,RC,86780,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",13.24,100,,12.98,12.98,12.98,"1 through 10","fee schedule","100% of CMS fee schedule",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.92,297,
"VARICELLA IgG",3086787,CDM,302,RC,86787,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,256.5,
"VENIPUNCTURE LAB",3036415,CDM,302,RC,36415,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.17,20.37,,6.60,5.85,7.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",25.29,56.2,,1.87,1.65,6.96,14,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.27,102,,,,,0,"fee schedule","102% of CMS fee schedule",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",9.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.18,90,,,,,0,"fee schedule","90% of CMS fee schedule",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9.09,100,,8.91,8.91,8.91,114,"fee schedule","100% of CMS fee schedule",9.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.18,40.5,
"WESTERN EQUINE IgG",3086654,CDM,302,RC,86654,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.15,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.45,102,,,,,0,"fee schedule","102% of CMS fee schedule",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,90,,,,,0,"fee schedule","90% of CMS fee schedule",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.87,162,
".CBC W/DIFF CHG",3085025,CDM,305,RC,85025,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.76,120.37,,11.15,9.12,11.41,"1 through 10","fee schedule","120.37% of GA fee schedule",154.55,56.2,,4.60,4.31,5.75,11,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",154.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.93,102,,,,,0,"fee schedule","102% of CMS fee schedule",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.23,125.18,,7.77,7.77,7.77,"1 through 10","fee schedule","125.18% of GA fee schedule",188.93,68.7,,107.25,107.25,107.25,"1 through 10","percent of total billed charges","68.7% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.99,90,,,,,0,"fee schedule","90% of CMS fee schedule",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.76,120.37,,7.77,7.77,7.77,32,"fee schedule","120.37% of GA fee schedule",7.77,100,,7.61,7.61,7.61,75,"fee schedule","100% of CMS fee schedule",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.99,247.5,
".D DIMER",3085379,CDM,305,RC,85379,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,14.61,11.95,14.95,"1 through 10","fee schedule","120.37% of GA fee schedule",202.32,56.2,,5.02,4.02,5.02,"1 through 10","percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,10.18,10.18,10.18,"1 through 10","fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,324,
".FACTOR VIII ONE STAGE",3085240,CDM,305,RC,85240,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",27.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18.26,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",27.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.11,202.5,
".FACTOR VIII, VW FACTOR",3085245,CDM,305,RC,85245,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",23.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,202.5,
".HEMOGRAM CHG",3085027,CDM,305,RC,85027,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.8,120.37,,9.29,9.29,9.29,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,4.79,4.79,4.79,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.8,120.37,,6.47,6.47,6.47,"1 through 10","fee schedule","120.37% of GA fee schedule",6.47,100,,6.34,6.34,6.34,25,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,180,
".PLATELET AGGREGATION",3085576,CDM,305,RC,85576,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.38,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",25.41,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",24.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.42,202.5,
.PTT,3000373,CDM,305,RC,85730,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.08,120.37,,6.65,6.65,6.65,"1 through 10","fee schedule","120.37% of GA fee schedule",115.21,56.2,,2.38,2.38,2.38,"1 through 10","percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.13,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.44,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.08,120.37,,6.01,6.01,6.01,"1 through 10","fee schedule","120.37% of GA fee schedule",6.01,100,,5.89,5.89,5.89,"1 through 10","fee schedule","100% of CMS fee schedule",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.41,184.5,
"3RD HISTAMINE RELEASE",3000801,CDM,305,RC,86343,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.2,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,324,
"3RD LUPUS TYPE ANTICOAG",3085400,CDM,305,RC,85400,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.92,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.94,297,
"3RD PROTEIN C (ACTIVITY) LEVEL",3085303,CDM,305,RC,85303,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",20.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.12,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.93,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.46,324,
"3RD PROTEIN C (ANTIGEN) LEVEL",3085302,CDM,305,RC,85302,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.61,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.25,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.93,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,324,
"3RD PROTEIN S (ACTIVITY) LEVEL",3085306,CDM,305,RC,85306,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,324,
"3RD RISTOCETIN CO FACTOR ASSA",3000264,CDM,305,RC,85245,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",23.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,90,,,,,0,"fee schedule","90% of CMS fee schedule",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.65,477,
"ANTITHROMBIN III ACTIVITY",3085300,CDM,305,RC,85300,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.09,102,,,,,0,"fee schedule","102% of CMS fee schedule",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.65,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.67,90,,,,,0,"fee schedule","90% of CMS fee schedule",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.67,351,
"ANTITHROMBIN III ANTIGEN",3085301,CDM,305,RC,85301,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.73,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.73,279,
"BLEEDING TIME",3085002,CDM,305,RC,85002,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.92,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.34,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.81,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.34,184.5,
"CLOT TIME LEE WHITE",3085345,CDM,305,RC,85345,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.1,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.78,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.22,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.22,184.5,
"D DIMER",3000567,CDM,305,RC,85379,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.41,120.37,,14.61,11.95,14.95,"1 through 10","fee schedule","120.37% of GA fee schedule",202.32,56.2,,5.02,4.02,5.02,"1 through 10","percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.02,125.18,,10.18,10.18,10.18,"1 through 10","fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.41,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.16,324,
"EOSIN COUNT BLOOD",3085009,CDM,305,RC,85004,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.6,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,139.5,
"FACTOR V ACTIVITY",3085220,CDM,305,RC,85220,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.95,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",18,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.71,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.89,382.5,
"FETAL SCREEN",3085461,CDM,305,RC,85461,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.17,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.42,126,
"FIBRIN DEGRADATION PRODUC",3085378,CDM,305,RC,85362,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.96,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.03,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.42,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.2,225,
"FIBRINOGEN ACTIVITY",3085384,CDM,305,RC,85384,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.64,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.37,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.75,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.75,202.5,
HEMATOCRIT,3085014,CDM,305,RC,85014,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.08,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.13,90,
HEMOGLOBIN,3085018,CDM,305,RC,85018,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.08,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.59,120.37,,3.40,3.40,3.40,"1 through 10","fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",2.37,100,,2.32,2.32,2.32,"1 through 10","fee schedule","100% of CMS fee schedule",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.13,90,
"IGF BINDING PROTEIN-3",3082397,CDM,305,RC,82397,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.36,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.4,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.71,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.71,90,
"KLEIHAUER BETKE",3085460,CDM,305,RC,85460,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.05,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.88,102,,,,,0,"fee schedule","102% of CMS fee schedule",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.96,90,,,,,0,"fee schedule","90% of CMS fee schedule",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.66,684,
"LAP STAIN",3085540,CDM,305,RC,85540,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.18,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.77,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,243,
LYSOZYME,3085549,CDM,305,RC,85549,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.38,130,,,,,0,"fee schedule","130% of CMS fee schedule",28.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.13,102,,,,,0,"fee schedule","102% of CMS fee schedule",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.53,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.88,90,,,,,0,"fee schedule","90% of CMS fee schedule",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.88,243,
"MANUAL DIFFERENTIAL",3085007,CDM,305,RC,85007,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.94,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.88,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.42,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.42,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.42,81,
"PLASMINOGEN ACTIVITY",3085420,CDM,305,RC,85420,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.88,90,,,,,0,"fee schedule","90% of CMS fee schedule",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.88,405,
"PLATELET COUNT(AUTOMATED)",3085049,CDM,305,RC,85049,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.57,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.03,103.5,
"PROTEIN C ACT RESISTANCE LEVEL",3085335,CDM,305,RC,85335,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.13,102,,,,,0,"fee schedule","102% of CMS fee schedule",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.49,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.58,504,
"PROTEIN S (ANTIGEN) LEVEL",3085305,CDM,305,RC,85305,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.45,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.45,324,
"PROTEIN S ANTIGEN FREE",3000648,CDM,305,RC,85306,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.92,130,,,,,0,"fee schedule","130% of CMS fee schedule",23.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.12,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",15.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.79,135,
"PROTIME (PT)",3085610,CDM,305,RC,85610,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.95,120.37,,5.09,4.51,5.67,"1 through 10","fee schedule","120.37% of GA fee schedule",70.25,56.2,,2.62,2.39,2.85,"1 through 10","percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.38,102,,,,,0,"fee schedule","102% of CMS fee schedule",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.18,125.18,,4.29,4.29,4.29,"1 through 10","fee schedule","125.18% of GA fee schedule",85.88,68.7,,121.32,121.32,121.32,"1 through 10","percent of total billed charges","68.7% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.86,90,,,,,0,"fee schedule","90% of CMS fee schedule",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.95,120.37,,4.29,4.29,4.29,"1 through 10","fee schedule","120.37% of GA fee schedule",4.29,100,,4.20,4.20,4.20,"1 through 10","fee schedule","100% of CMS fee schedule",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.86,112.5,
PTT,3085730,CDM,305,RC,85730,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.08,120.37,,6.65,6.65,6.65,"1 through 10","fee schedule","120.37% of GA fee schedule",115.21,56.2,,2.38,2.38,2.38,"1 through 10","percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.21,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.13,102,,,,,0,"fee schedule","102% of CMS fee schedule",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.44,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.08,120.37,,6.01,6.01,6.01,"1 through 10","fee schedule","120.37% of GA fee schedule",6.01,100,,5.89,5.89,5.89,"1 through 10","fee schedule","100% of CMS fee schedule",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.41,184.5,
"RBC BF",3000721,CDM,305,RC,89050,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,
RBC(AUTOMATED),3085041,CDM,305,RC,85041,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.72,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.72,90,
"RETIC COUNT",3085045,CDM,305,RC,85045,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.19,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,3.95,3.95,3.95,"1 through 10","percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.07,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.3,125.18,,3.99,3.99,3.99,"1 through 10","fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.99,100,,3.91,3.91,3.91,"1 through 10","fee schedule","100% of CMS fee schedule",3.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.59,139.5,
"SEDIMENTATION RATE",3085651,CDM,305,RC,85651,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",5.37,120.37,,3.93,3.93,3.93,"1 through 10","fee schedule","120.37% of GA fee schedule",95.54,56.2,,3.43,2.79,4.06,"1 through 10","percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",95.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.58,125.18,,4.27,4.27,4.27,"1 through 10","fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.37,120.37,,4.27,4.27,4.27,"1 through 10","fee schedule","120.37% of GA fee schedule",4.27,100,,4.18,4.18,4.18,"1 through 10","fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,153,
"SICKLE CELL PREP",3085660,CDM,305,RC,85660,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",123.64,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.62,102,,,,,0,"fee schedule","102% of CMS fee schedule",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.69,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.96,90,,,,,0,"fee schedule","90% of CMS fee schedule",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.96,198,
"THROMBIN TIME",3085670,CDM,305,RC,85670,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.74,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.19,324,
"UNUSUAL SLIDE/PATH READ",3085060,CDM,305,RC,85060,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",32.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.75,103.5,
"WBC (AUTOMATED)",3085048,CDM,305,RC,85048,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.3,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.85,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.85,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.29,90,
"WBC BF",3000720,CDM,305,RC,89050,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,
".AFB CULTURE (AFB S&C)",3087015,CDM,306,RC,87015,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.68,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.52,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.68,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.01,225,
".AFB SMEAR (AFB S&C)",3087206,CDM,306,RC,87206,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.85,126,
".CAMPYLOBACTER ANTIGEN",3087899,CDM,306,RC,87449,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",44.96,56.2,,7.55,7.19,7.90,"1 through 10","percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,72,
".CC URINE COLONY COUNT",3087086,CDM,306,RC,87086,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.49,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,3.19,3.18,3.50,"1 through 10","percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.71,125.18,,8.07,8.07,8.07,"1 through 10","fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.26,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,120.37,,8.07,8.07,8.07,"1 through 10","fee schedule","120.37% of GA fee schedule",8.07,100,,7.91,7.91,7.91,"1 through 10","fee schedule","100% of CMS fee schedule",8.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.26,207,
".CHLAMYDIA (DNA PROBE)",3087490,CDM,306,RC,87490,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.58,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.85,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",23.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.48,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.85,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.48,180,
".CULTURE ANAEROBIC CPLSE",3000566,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
".CULTURE FUNGUS/BLOOD",3087103,CDM,306,RC,87103,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.6,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",20.87,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.41,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.65,288,
".CULTURE MYCOBACTERIA",3087116,CDM,306,RC,87116,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.04,130,,,,,0,"fee schedule","130% of CMS fee schedule",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",11.02,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.8,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,225,
".CULTURE SPUTUM CPLSE",3000391,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
".CULTURE STOOL",3000665,CDM,306,RC,87045,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9.44,100,,9.25,9.25,9.25,"1 through 10","fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,94.5,
".CULTURE URINE (EFCH)",3000811,CDM,306,RC,87088,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,3.20,3.20,3.52,"1 through 10","percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.25,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.74,125.18,,8.09,8.09,8.09,"1 through 10","fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.25,120.37,,8.09,8.09,8.09,"1 through 10","fee schedule","120.37% of GA fee schedule",8.09,100,,7.93,7.93,7.93,"1 through 10","fee schedule","100% of CMS fee schedule",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.28,256.5,
".CYTOGENTETICS 100-300",3088291,CDM,306,RC,88275,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",60.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",52.21,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.07,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.07,180,
".FUNGUS STAIN",3000117,CDM,306,RC,87206,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.85,126,
".GC (DNA PROBE)",3000120,CDM,306,RC,87590,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.94,130,,,,,0,"fee schedule","130% of CMS fee schedule",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.42,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.19,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.19,180,
".INDIA INK PREP",3000169,CDM,306,RC,87210,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.94,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,103.5,
".INFECTIOUS AGENT BY NA AP",3000170,CDM,306,RC,87798,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",35.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",30.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.58,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.7,490.5,
".MIC SUSCEPTIBILITY PANEL",3087186,CDM,306,RC,87186,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.08,120.37,,12.41,12.41,12.41,"1 through 10","fee schedule","120.37% of GA fee schedule",112.4,56.2,,3.42,3.42,4.10,"1 through 10","percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.61,125.18,,8.65,8.65,8.65,"1 through 10","fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.08,120.37,,8.65,8.65,8.65,"1 through 10","fee schedule","120.37% of GA fee schedule",8.65,100,,8.48,8.48,8.48,"1 through 10","fee schedule","100% of CMS fee schedule",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,180,
".MYCOBACTERIA STAIN",3000218,CDM,306,RC,87206,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.01,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.85,126,
".SHIGA TOXIN 1",3000663,CDM,306,RC,87045,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9.44,100,,9.25,9.25,9.25,"1 through 10","fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,72,
".SHIGA TOXIN 2",3000664,CDM,306,RC,87427,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",44.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,72,
"3RD CLOSTRIDIUM DIFFICILE PCR",3087493,CDM,306,RC,87493,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.45,130,,,,,0,"fee schedule","130% of CMS fee schedule",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",38.02,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.54,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.54,490.5,
"3RD CRYPTOSPORIDIUM, STOOL",3087328,CDM,306,RC,87328,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.1,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.44,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.44,126,
"3RD CULTURE STOOL-ECOLI 0157",3000072,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.57,126,
"3RD CULTURE VIBRIO (STOOL)",3000074,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.57,382.5,
"3RD CULTURE VIRAL",3000075,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,324,
"3RD GRAM STAIN QUEST",3000558,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.69,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.55,135,
"3RD HEP C RNA QUANTITATIVE",3087522,CDM,306,RC,87522,HCPCS,OUTPATIENT,,,970,776,,824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",545.14,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.14,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",873,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",666.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",562.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",64.84,120.37,,42.84,42.84,42.84,"1 through 10","fee schedule","120.37% of GA fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,873,
"3RD HEP C VIRAL LOAD",3000546,CDM,306,RC,87522,HCPCS,OUTPATIENT,,,970,776,,824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",545.14,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.14,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",873,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",666.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",562.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",64.84,120.37,,42.84,42.84,42.84,"1 through 10","fee schedule","120.37% of GA fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,873,
"3RD HEP E VIRUS",3000813,CDM,306,RC,86790,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.74,130,,,,,0,"fee schedule","130% of CMS fee schedule",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",13.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.5,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.59,490.5,
"3RD HEPATITIS B  QUANT",3087517,CDM,306,RC,87517,HCPCS,OUTPATIENT,,,1560,1248,,1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.69,130,,,,,0,"fee schedule","130% of CMS fee schedule",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.7,102,,,,,0,"fee schedule","102% of CMS fee schedule",1404,90,,,,,0,"percent of total billed charges","90% of total billed charges",67.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1071.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",904.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",64.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.56,1404,
"3RD HIV RNA BY PCR",3087536,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.63,130,,,,,0,"fee schedule","130% of CMS fee schedule",68.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",86.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",70.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.01,760.5,
"3RD HIV VIRAL LOAD",3000153,CDM,306,RC,87536,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.63,130,,,,,0,"fee schedule","130% of CMS fee schedule",68.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",86.8,102,,,,,0,"fee schedule","102% of CMS fee schedule",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",70.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.01,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",85.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.01,760.5,
"3RD LACOSAMIDE/VIMPAT",3000661,CDM,306,RC,80299,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.23,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",19.01,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.95,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",18.64,100,,18.27,18.27,18.27,"1 through 10","fee schedule","100% of CMS fee schedule",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.78,166.5,
"3RD MALARIA SMEAR",3000191,CDM,306,RC,87207,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,126,
"ANAEROBIC IDENTIFICATION",3087076,CDM,306,RC,87076,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.27,63,
"CULTURE ANAEROBIC",3087075,CDM,306,RC,87075,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.31,130,,,,,0,"fee schedule","130% of CMS fee schedule",14.32,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.66,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.32,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.52,288,
"CULTURE BLOOD",3087040,CDM,306,RC,87040,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.42,130,,,,,0,"fee schedule","130% of CMS fee schedule",15.62,120.37,,13.13,11.78,14.47,"1 through 10","fee schedule","120.37% of GA fee schedule",174.22,56.2,,4.34,4.08,4.95,"1 through 10","percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",10.53,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",16.25,125.18,,10.32,10.32,10.32,"1 through 10","fee schedule","125.18% of GA fee schedule",212.97,68.7,,120.90,120.90,120.90,"1 through 10","percent of total billed charges","68.7% of total billed charges",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.29,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.62,120.37,,10.32,10.32,10.32,"1 through 10","fee schedule","120.37% of GA fee schedule",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.29,279,
"CULTURE BODY FLUID",3000708,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE CAMPYLOBACTER",3087046,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.57,126,
"CULTURE CERVICAL",3000351,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",129.26,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,207,
"CULTURE CYTOMEGALOVIRUS",3087252,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,279,
"CULTURE FUNGUS/NAIL/SKIN",3087101,CDM,306,RC,87101,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.02,130,,,,,0,"fee schedule","130% of CMS fee schedule",11.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.86,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.13,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.94,288,
"CULTURE FUNGUS/OTHER",3087102,CDM,306,RC,87102,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.58,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,288,
"CULTURE GC",3087081,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,207,
"CULTURE GROUP B STREP",3000376,CDM,306,RC,87081,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.26,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.76,102,,,,,0,"fee schedule","102% of CMS fee schedule",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.97,207,
"CULTURE HERPES",3000067,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,324,
"CULTURE NOSE-THROAT",3000069,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",160.17,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,256.5,
"CULTURE OTHER",3000070,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE OTHER",3000565,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE SPUTUM",3000071,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE URINE",3087088,CDM,306,RC,87088,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,3.20,3.20,3.52,"1 through 10","percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.25,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.74,125.18,,8.09,8.09,8.09,"1 through 10","fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.25,120.37,,8.09,8.09,8.09,"1 through 10","fee schedule","120.37% of GA fee schedule",8.09,100,,7.93,7.93,7.93,"1 through 10","fee schedule","100% of CMS fee schedule",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.28,256.5,
"CULTURE VAGINAL",3000073,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE WOUND",3000390,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",179.84,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",179.84,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,288,
"CULTURE YERSINIA (STOOL)",3000078,CDM,306,RC,87046,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.27,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",9.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.5,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.57,126,
"ENTAMOEBA HISTOLYTICA  ANTIGEN",3087337,CDM,306,RC,87337,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,81,
"FERN TEST",3087210,CDM,306,RC,87210,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.94,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,126,
"GRAM STAIN",3087205,CDM,306,RC,87205,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.69,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.55,135,
"GROUP B STREP ID",3087158,CDM,306,RC,87158,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.06,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.97,49.5,
"HAEMOPHILUS ID",3000140,CDM,306,RC,87158,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.06,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.89,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.24,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.97,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.92,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.97,49.5,
"ID ONLY",3000350,CDM,306,RC,87077,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.5,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.23,120.37,,11.59,11.59,11.59,"1 through 10","fee schedule","120.37% of GA fee schedule",39.34,56.2,,4.79,4.78,5.74,"1 through 10","percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.24,102,,,,,0,"fee schedule","102% of CMS fee schedule",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.72,125.18,,8.08,8.08,8.08,"1 through 10","fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.23,120.37,,8.08,8.08,8.08,"1 through 10","fee schedule","120.37% of GA fee schedule",8.08,100,,7.92,7.92,7.92,"1 through 10","fee schedule","100% of CMS fee schedule",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.27,63,
"KOH PREP",3087220,CDM,306,RC,87220,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,94.5,
"MRSA SCREEN, NASAL",3000553,CDM,306,RC,87070,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.04,120.37,,12.36,12.36,12.36,"1 through 10","fee schedule","120.37% of GA fee schedule",160.17,56.2,,3.41,3.41,3.41,"1 through 10","percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.79,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.04,120.37,,8.62,8.62,8.62,"1 through 10","fee schedule","120.37% of GA fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.76,256.5,
"NOROVIRUS STOOL LEVEL",3087449,CDM,306,RC,87449,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,7.55,7.19,7.90,"1 through 10","percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,39.00,39.00,39.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,11.74,11.74,11.74,"1 through 10","fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,256.5,
"PIN WORM PREP",3087172,CDM,306,RC,87172,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.55,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.36,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.84,126,
"PYLOPLUS RAPID UREASE TEST",3087077,CDM,306,RC,87339,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.8,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,13.28,11.16,14.02,"1 through 10","fee schedule","120.37% of GA fee schedule",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",140.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",16.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.4,90,,,,,0,"fee schedule","90% of CMS fee schedule",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,16.00,16.00,16.00,"1 through 10","fee schedule","120.37% of GA fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.4,225,
"RAPID STREP Gp A TEST",3087430,CDM,306,RC,87430,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,17.21,17.21,17.21,"1 through 10","fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",17.15,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,16.81,16.81,16.81,"1 through 10","fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,16.81,16.81,16.81,"1 through 10","fee schedule","120.37% of GA fee schedule",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.13,90,
"ROTA VIRUS STOOL",3087425,CDM,306,RC,87425,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.22,102,,,,,0,"fee schedule","102% of CMS fee schedule",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,90,,,,,0,"fee schedule","90% of CMS fee schedule",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.98,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.78,342,
"RSV (SWAB)",3087420,CDM,306,RC,87420,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.08,130,,,,,0,"fee schedule","130% of CMS fee schedule",18.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",14.19,102,,,,,0,"fee schedule","102% of CMS fee schedule",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.88,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.52,90,,,,,0,"fee schedule","90% of CMS fee schedule",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.15,120.37,,13.91,13.91,13.91,"1 through 10","fee schedule","120.37% of GA fee schedule",13.91,100,,13.63,13.63,13.63,"1 through 10","fee schedule","100% of CMS fee schedule",13.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.52,301.5,
"SENSITIVITY STUDY",3087184,CDM,306,RC,87186,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",13.08,120.37,,12.41,12.41,12.41,"1 through 10","fee schedule","120.37% of GA fee schedule",73.06,56.2,,3.42,3.42,4.10,"1 through 10","percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.06,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.61,125.18,,8.65,8.65,8.65,"1 through 10","fee schedule","125.18% of GA fee schedule",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,90,,,,,0,"fee schedule","90% of CMS fee schedule",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.08,120.37,,8.65,8.65,8.65,"1 through 10","fee schedule","120.37% of GA fee schedule",8.65,100,,8.48,8.48,8.48,"1 through 10","fee schedule","100% of CMS fee schedule",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,117,
"THYROXINE BINDING GLOBULIN",3000731,CDM,306,RC,84442,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.21,130,,,,,0,"fee schedule","130% of CMS fee schedule",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",15.08,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.3,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.61,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",14.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.3,49.5,
"TZANCK PREP",3000320,CDM,306,RC,87207,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",126.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,202.5,
"VIRAL STUDIES",3000331,CDM,306,RC,87252,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.89,130,,,,,0,"fee schedule","130% of CMS fee schedule",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",202.32,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",26.59,102,,,,,0,"fee schedule","102% of CMS fee schedule",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,90,,,,,0,"fee schedule","90% of CMS fee schedule",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.46,324,
"WET PREP",3000335,CDM,306,RC,87210,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,130,,,,,0,"fee schedule","130% of CMS fee schedule",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.01,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.94,102,,,,,0,"fee schedule","102% of CMS fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,90,,,,,0,"fee schedule","90% of CMS fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.24,94.5,
"YEAST  ID",3000336,CDM,306,RC,87102,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",12.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",8.58,102,,,,,0,"fee schedule","102% of CMS fee schedule",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,90,,,,,0,"fee schedule","90% of CMS fee schedule",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.57,63,
".HLA CLASS 1 LOCUS",3081373,CDM,307,RC,81373,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",165.66,130,,,,,0,"fee schedule","130% of CMS fee schedule",118.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",129.98,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",123.18,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.69,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",118.44,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",127.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.69,256.5,
".HLA CLASS 2 ANTIGEN",3081377,CDM,307,RC,81377,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.16,130,,,,,0,"fee schedule","130% of CMS fee schedule",48.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",96.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",85.27,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",48.15,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",94.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.15,256.5,
".URINALYSIS COMPLETE",3081001,CDM,307,RC,81001,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.8,120.37,,4.62,4.56,4.68,"1 through 10","fee schedule","120.37% of GA fee schedule",30.91,56.2,,2.00,1.80,2.83,"1 through 10","percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.99,125.18,,3.17,3.17,3.17,"1 through 10","fee schedule","125.18% of GA fee schedule",37.79,68.7,,37.07,37.07,37.07,"1 through 10","percent of total billed charges","68.7% of total billed charges",3.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.8,120.37,,3.17,3.17,3.17,"1 through 10","fee schedule","120.37% of GA fee schedule",3.17,100,,3.11,3.11,3.11,24,"fee schedule","100% of CMS fee schedule",3.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.85,49.5,
".VOLUME MEASUREMENT 24HR",3081050,CDM,307,RC,81050,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.73,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.54,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.54,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.28,49.5,
"ALBUMIN URINE WITHOUT CREATININE",3082043,CDM,307,RC,82043,HCPCS,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",160.17,56.2,,5.72,5.72,5.72,"1 through 10","percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",160.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.9,102,,,,,0,"fee schedule","102% of CMS fee schedule",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,90,,,,,0,"fee schedule","90% of CMS fee schedule",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.76,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.78,100,,5.66,5.66,5.66,"1 through 10","fee schedule","100% of CMS fee schedule",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.2,256.5,
"URINALYSIS BLOOD",3000322,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,58.5,
"URINALYSIS DIPSTICK",3081003,CDM,307,RC,81003,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.93,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.41,120.37,,2.61,2.11,3.11,"1 through 10","fee schedule","120.37% of GA fee schedule",56.2,56.2,,1.33,1.23,1.66,"1 through 10","percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.54,125.18,,2.25,2.25,2.25,"1 through 10","fee schedule","125.18% of GA fee schedule",68.7,68.7,,50.70,50.70,50.70,"1 through 10","percent of total billed charges","68.7% of total billed charges",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.03,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.41,120.37,,2.25,2.25,2.25,17,"fee schedule","120.37% of GA fee schedule",2.25,100,,2.20,2.20,2.20,45,"fee schedule","100% of CMS fee schedule",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.03,90,
"URINALYSIS GLUCOSE",3000323,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,49.5,
"URINALYSIS KETONE",3000324,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,58.5,
"URINALYSIS MICROSCO",3081015,CDM,307,RC,81015,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,130,,,,,0,"fee schedule","130% of CMS fee schedule",4.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.2,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.75,90,,,,,0,"fee schedule","90% of CMS fee schedule",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.75,90,
"URINALYSIS PROTEIN",300235,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,58.5,
"URINALYSIS PROTEIN",3000325,CDM,307,RC,81002,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.52,130,,,,,0,"fee schedule","130% of CMS fee schedule",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.53,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",3.55,102,,,,,0,"fee schedule","102% of CMS fee schedule",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.02,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,90,,,,,0,"fee schedule","90% of CMS fee schedule",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.86,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.13,58.5,
".SPERM COUNT-POST VAS",3089321,CDM,309,RC,89321,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.67,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.29,102,,,,,0,"fee schedule","102% of CMS fee schedule",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",12.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,103.5,
"3RD FAT STOOL QUAL",3089125,CDM,309,RC,82705,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.2,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.59,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",5.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.59,166.5,
"CELL CO BODY FLUID W DIF",3089051,CDM,309,RC,89051,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.28,130,,,,,0,"fee schedule","130% of CMS fee schedule",2.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.71,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",5.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.66,126,
"CELL CO BODY FLUID WO DIF",3000041,CDM,309,RC,89050,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,126,
"CELL CO JOINT FLUID/DIFF",3089050,CDM,309,RC,89050,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,126,
"CELL COUNT PERITINEAL",3000043,CDM,309,RC,89050,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",4.81,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.45,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",4.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.25,126,
"CRYSTALS ANY BODY FLUID",3089060,CDM,309,RC,89060,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.48,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.6,166.5,
"CRYSTALS KNEE FLUID",3000064,CDM,309,RC,89060,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",10.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",7.48,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.6,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",7.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.6,166.5,
"EOSIN SMEAR NASAL",3089190,CDM,309,RC,89190,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.53,130,,,,,0,"fee schedule","130% of CMS fee schedule",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",5.91,102,,,,,0,"fee schedule","102% of CMS fee schedule",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.49,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.21,90,,,,,0,"fee schedule","90% of CMS fee schedule",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.2,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",5.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.21,139.5,
"GASTRIC ANALYSIS",3089130,CDM,309,RC,82930,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.72,130,,,,,0,"fee schedule","130% of CMS fee schedule",26.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.84,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.85,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",6.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.04,297,
"SEX HORMONE BINDING GLOBULIN",3084270,CDM,309,RC,84270,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.25,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.16,102,,,,,0,"fee schedule","102% of CMS fee schedule",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.2,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.56,90,,,,,0,"fee schedule","90% of CMS fee schedule",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.89,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",21.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.56,126,
"SPERM COUNT",3089320,CDM,309,RC,89320,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",16,130,,,,,0,"fee schedule","130% of CMS fee schedule",8.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",12.56,102,,,,,0,"fee schedule","102% of CMS fee schedule",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.08,90,,,,,0,"fee schedule","90% of CMS fee schedule",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.73,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",12.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,297,
"TRANSFERRIN RECEPTOR ASSAY SOLUABLE",84238,CDM,309,RC,84238,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.54,130,,,,,0,"fee schedule","130% of CMS fee schedule",55.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",103.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",37.3,102,,,,,0,"fee schedule","102% of CMS fee schedule",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.91,90,,,,,0,"fee schedule","90% of CMS fee schedule",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",55.35,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",,,,,,,0,other,"not separately reimbursable",36.57,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.91,166.5,
"88300 SURGICAL PATHOLOGY LEVEL 1",3200005,CDM,310,RC,88300,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",17.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.7,102,,,,,0,"fee schedule","102% of CMS OPPS rate",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,90,,,,,0,"fee schedule","90% of CMS OPPS rate",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.21,49.5,
"88304 SURGICAL PATHOLOGY LEVEL III",3200007,CDM,310,RC,88304,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",36.33,162,
"88305 SURGICAL PATHOLOGY LEVEL IV",3200008,CDM,310,RC,88305,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",79.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",82.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,162,
"88307 SURGICAL PATHOLOGY LEVEL V",3200009,CDM,310,RC,88307,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",424.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",160.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",333.42,102,,,,,0,"fee schedule","102% of CMS OPPS rate",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.86,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",294.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",160.45,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",326.89,100,,,,,0,"fee schedule","100% of CMS OPPS rate",151.74,424.95,
"88309 SURGICAL PATHOLOGY LEVEL VI",3200010,CDM,310,RC,88309,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",965.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",226.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",151.74,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",757.19,102,,,,,0,"fee schedule","102% of CMS OPPS rate",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",235.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",668.11,90,,,,,0,"fee schedule","90% of CMS OPPS rate",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",226.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",742.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",151.74,965.05,
"88311 DECALCIFICATION PROCEDURE",3200011,CDM,310,RC,88311,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",30.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.75,49.5,
"88312 SPECIAL STAIN; INTER AND REPT",3200012,CDM,310,RC,88312,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",52.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.32,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,81,
"88313 SPECIAL STAIN GROUP II",3200013,CDM,310,RC,88313,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",54.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",56.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",54.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.58,152.27,
"88342 IHC, EACH ANTIBODY",3200014,CDM,310,RC,88342,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.6,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.16,202.43,
".3 KARYOTYPES & BANDING",3088280,CDM,311,RC,88280,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.51,130,,,,,0,"fee schedule","130% of CMS fee schedule",37.99,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",34.14,102,,,,,0,"fee schedule","102% of CMS fee schedule",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",39.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.12,90,,,,,0,"fee schedule","90% of CMS fee schedule",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.99,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.12,630,
".30 CELL COUNT(CHROMOSOME",3088262,CDM,311,RC,88262,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",188.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",128,102,,,,,0,"fee schedule","102% of CMS fee schedule",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",196.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.94,630,
".CHROM ANAL15-20(CHROM7&11",3000049,CDM,311,RC,88262,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.14,130,,,,,0,"fee schedule","130% of CMS fee schedule",188.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",128,102,,,,,0,"fee schedule","102% of CMS fee schedule",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",196.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.94,90,,,,,0,"fee schedule","90% of CMS fee schedule",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",125.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.94,972,
".CHROM ANAL20-25(CHROM7&11",3088264,CDM,311,RC,88264,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",187.99,130,,,,,0,"fee schedule","130% of CMS fee schedule",188.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",147.5,102,,,,,0,"fee schedule","102% of CMS fee schedule",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",196.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.15,90,,,,,0,"fee schedule","90% of CMS fee schedule",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",188.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",144.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.15,972,
".CHROMOSOME BASE (C FG X)",3088248,CDM,311,RC,88248,HCPCS,OUTPATIENT,,,1560,1248,,1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",225.12,130,,,,,0,"fee schedule","130% of CMS fee schedule",262.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",176.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",1404,90,,,,,0,"percent of total billed charges","90% of total billed charges",272.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1071.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",155.85,90,,,,,0,"fee schedule","90% of CMS fee schedule",904.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",262.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",173.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",155.85,1404,
".CYTOGENETICS, INTERP/REPO",3000106,CDM,311,RC,88291,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
".MOLECULAR CYTO 25-99 CELL",3088274,CDM,311,RC,88274,HCPCS,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.09,130,,,,,0,"fee schedule","130% of CMS fee schedule",52.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",320.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",320.34,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",43.23,102,,,,,0,"fee schedule","102% of CMS fee schedule",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.79,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.14,90,,,,,0,"fee schedule","90% of CMS fee schedule",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.14,513,
".MOLECULAR CYTO DNA PROBE",3088271,CDM,311,RC,88271,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.85,130,,,,,0,"fee schedule","130% of CMS fee schedule",32.43,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",196.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",21.85,102,,,,,0,"fee schedule","102% of CMS fee schedule",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.72,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.28,90,,,,,0,"fee schedule","90% of CMS fee schedule",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.43,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.28,315,
".PRADER-WILLI BY FISH-A",3088230,CDM,311,RC,88230,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",151.44,130,,,,,0,"fee schedule","130% of CMS fee schedule",176.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",118.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",183.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",104.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",104.84,972,
".TISSUE CULT(CHROM 7 & 11)",3088237,CDM,311,RC,88237,HCPCS,OUTPATIENT,,,870,696,,739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",186.88,130,,,,,0,"fee schedule","130% of CMS fee schedule",133.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",488.94,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.94,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.63,102,,,,,0,"fee schedule","102% of CMS fee schedule",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",138.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",597.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.38,90,,,,,0,"fee schedule","90% of CMS fee schedule",504.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.63,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.38,783,
".TISSUE CULTURE NON NEOPLA",3000305,CDM,311,RC,88230,HCPCS,OUTPATIENT,,,1260,1008,,1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",151.44,130,,,,,0,"fee schedule","130% of CMS fee schedule",176.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",708.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",708.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",118.82,102,,,,,0,"fee schedule","102% of CMS fee schedule",1134,90,,,,,0,"percent of total billed charges","90% of total billed charges",183.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",865.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",104.84,90,,,,,0,"fee schedule","90% of CMS fee schedule",730.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",104.84,1134,
"3RD FLOW CYTOMETRY",3088182,CDM,311,RC,88182,HCPCS,OUTPATIENT,,,930,744,,790.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",80.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",522.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",525.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",522.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",525.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",837,90,,,,,0,"percent of total billed charges","90% of total billed charges",83.82,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",638.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",539.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",80.6,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",790.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,837,
"88104 CYTOPATHOLOGY FL NONGYN SMEARS",3200002,CDM,311,RC,88104,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",51.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",53.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,81,
"88108 CP CONCENTRATION TECH SMEAR",3200003,CDM,311,RC,88108,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",55.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.58,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",57.26,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",55.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.1,81,
"88173 CP INTERPRETATION AND REPORT",3200004,CDM,311,RC,88173,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",110.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",114.64,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",110.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,162,
"CD4 COUNT",3086361,CDM,311,RC,86361,HCPCS,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.81,130,,,,,0,"fee schedule","130% of CMS fee schedule",39.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",281,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.32,102,,,,,0,"fee schedule","102% of CMS fee schedule",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",41.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.1,90,,,,,0,"fee schedule","90% of CMS fee schedule",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",39.51,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.1,450,
".PRADER-WILLI BY FISH-B",3088365,CDM,312,RC,88365,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",106.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",185.46,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",158.83,102,,,,,0,"fee schedule","102% of CMS OPPS rate",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",110.38,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",140.14,90,,,,,0,"fee schedule","90% of CMS OPPS rate",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",106.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",155.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",106.14,297,
"GIEMSA STAIN",3088313,CDM,312,RC,87207,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.79,130,,,,,0,"fee schedule","130% of CMS fee schedule",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",6.11,102,,,,,0,"fee schedule","102% of CMS fee schedule",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,90,,,,,0,"fee schedule","90% of CMS fee schedule",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.39,279,
"PAS STAIN",3000227,CDM,312,RC,88312,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.12,130,,,,,0,"fee schedule","130% of CMS OPPS rate",52.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",49.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.32,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.23,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",48.55,100,,,,,0,"fee schedule","100% of CMS OPPS rate",43.69,351,
"BD BONE DENSITY HIP /PELVIS",4176075,CDM,320,RC,77080,HCPCS,OUTPATIENT,,,870,696,,739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",491.55,56.5,,10.49,8.39,77.34,24,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.94,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",597.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",504.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",177.22,20.37,,95.28,62.78,127.78,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,94.71,94.71,94.71,115,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,783,
"BD BONE MIN DENSITY VERT FRX",4176077,CDM,320,RC,77080,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,10.49,8.39,77.34,24,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,95.28,62.78,127.78,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,94.71,94.71,94.71,115,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",31.57,139.5,
"BREAST BIOPSY",4019102,CDM,320,RC,19081,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",167.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",376.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",136.48,603,
"INSERT NON-TUNNEL CV CATH",4036556,CDM,320,RC,36556,HCPCS,OUTPATIENT,,,12000,9600,,10200,85,,,,,0,"percent of total billed charges","85% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2444.4,20.37,,78.83,78.83,78.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",6780,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6780,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6780,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",6744,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",10800,90,,,,,0,"percent of total billed charges","90% of total billed charges",4200,35,,,,,0,"percent of total billed charges","35% of total billed charges",8244,68.7,,5294.72,5294.72,5294.72,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10800,90,,,,,0,"percent of total billed charges","90% of total billed charges",6960,58,,,,,0,"percent of total billed charges","58% of total billed charges",2444.4,20.37,,324.09,324.09,324.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,2242.45,2242.45,2242.45,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10200,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2444.4,10800,
"NEEDLE BIOPSY LYMPH NODES",4038505,CDM,320,RC,38505,HCPCS,OUTPATIENT,,,5920,4736,,5032,85,,,,,0,"percent of total billed charges","85% of total billed charges",1480,25,,,,,0,"percent of total billed charges","25% of total billed charges",1480,25,,,,,0,"percent of total billed charges","25% of total billed charges",1480,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1205.9,20.37,,964.35,964.35,964.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",3344.8,56.5,,2176.58,2176.58,2176.58,"1 through 10","percent of total billed charges","50.56% of total billed charges",3344.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3344.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3327.04,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",5328,90,,,,,0,"percent of total billed charges","90% of total billed charges",2072,35,,,,,0,"percent of total billed charges","35% of total billed charges",4067.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5328,90,,,,,0,"percent of total billed charges","90% of total billed charges",3433.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1205.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5032,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1205.9,5328,
"US CAROTID UNI RIGHT",4693882,CDM,320,RC,93882,HCPCS,OUTPATIENT,,,1300,1040,,1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",730.6,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",455,35,,,,,0,"percent of total billed charges","35% of total billed charges",893.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",754,58,,,,,0,"percent of total billed charges","58% of total billed charges",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,1170,
"US GUIDANCE CYS/ANY LOCATION",4600009,CDM,320,RC,76942,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",181.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",181.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",181.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",147.68,20.37,,117.68,117.68,117.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",407.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,186.79,186.79,186.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",147.68,652.5,
"XR A C JOINTS",4073050,CDM,320,RC,73050,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR ABD/KUB",4074000,CDM,320,RC,74018,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",79.44,20.37,,33.26,10.65,55.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",220.35,56.5,,16.00,8.24,51.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,60.30,60.30,60.30,"1 through 10","percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,62.26,62.26,62.26,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,351,
"XR ABDOMEN FLATUPRIGHT",4074020,CDM,320,RC,74018,HCPCS,OUTPATIENT,,,540,432,,459,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",110,20.37,,33.26,10.65,55.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",305.1,56.5,,16.00,8.24,51.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",303.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",189,35,,60.30,60.30,60.30,"1 through 10","percent of total billed charges","35% of total billed charges",370.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",313.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",110,20.37,,62.26,62.26,62.26,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",459,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,486,
"XR ABDOMINAL SERIES",4074022,CDM,320,RC,74022,HCPCS,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",130.37,20.37,,100.96,100.96,100.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",361.6,56.5,,16.88,7.43,76.83,"1 through 10","percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",359.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,102.18,102.18,102.18,"1 through 10","percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,576,
"XR ABDOMINAL SERIES PORTABLE",4007402,CDM,320,RC,74022,HCPCS,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",130.37,20.37,,100.96,100.96,100.96,"1 through 10","percent of total billed charges","20.37% of total billed charges",361.6,56.5,,16.88,7.43,76.83,"1 through 10","percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",359.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,102.18,102.18,102.18,"1 through 10","percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,576,
"XR ANKLE LIMITED LT",4073600,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",62.13,20.37,,49.69,49.69,49.69,"1 through 10","percent of total billed charges","20.37% of total billed charges",172.33,56.5,,7.10,7.10,7.10,"1 through 10","percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,47.16,47.16,47.16,"1 through 10","percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",62.13,274.5,
"XR ANKLE LIMITED RT",4083600,CDM,320,RC,73600,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",62.13,20.37,,49.69,49.69,49.69,"1 through 10","percent of total billed charges","20.37% of total billed charges",172.33,56.5,,7.10,7.10,7.10,"1 through 10","percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",171.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,47.16,47.16,47.16,"1 through 10","percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",62.13,274.5,
"XR ANKLE LT 3 VIEWS",4083610,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,61.66,56.08,67.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,9.37,7.50,59.64,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,13.00,13.00,13.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR ANKLE RT 3 VIEWS",4073610,CDM,320,RC,73610,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,61.66,56.08,67.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,9.37,7.50,59.64,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,13.00,13.00,13.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR ASPIR FINE NDLE W IMAGE G",4010022,CDM,320,RC,10005,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,50.72,50.72,50.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",437.88,56.5,,722.87,69.70,1832.23,"1 through 10","percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",435.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,501.27,476.90,501.27,"1 through 10","fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,831.18,
"XR ASPIR FINE NDLE W/O IMGE G",4010021,CDM,320,RC,10021,HCPCS,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,67.92,67.92,67.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",413.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",149.72,661.5,
"XR BARIUM ENEMA - BE",4074270,CDM,320,RC,74270,HCPCS,OUTPATIENT,,,1260,1008,,1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",256.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",708.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1134,90,,,,,0,"percent of total billed charges","90% of total billed charges",441,35,,,,,0,"percent of total billed charges","35% of total billed charges",865.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",730.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",256.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1134,
"XR BARIUM ENEMA AIR CON",4074280,CDM,320,RC,74280,HCPCS,OUTPATIENT,,,1560,1248,,1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",317.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",876.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1404,90,,,,,0,"percent of total billed charges","90% of total billed charges",546,35,,,,,0,"percent of total billed charges","35% of total billed charges",1071.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",904.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",317.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1404,
"XR BARIUM SWALLOW",4074220,CDM,320,RC,74220,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",500.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,801,
"XR BARIUM SWALLOW/MODIFIED",4074230,CDM,320,RC,74230,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",186.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",514.23,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,823.5,
"XR BONE AGE",4076020,CDM,320,RC,77072,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",79.44,351,
"XR BONE SURVEY-COMPLETE",4076062,CDM,320,RC,77075,HCPCS,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",635.63,56.5,,19.33,19.33,19.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",393.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,1012.5,
"XR CLAVICLE LT",4073000,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,60.74,60.74,60.74,"1 through 10","percent of total billed charges","20.37% of total billed charges",217.53,56.5,,7.64,7.64,7.64,"1 through 10","percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR CLAVICLE RT",4072220,CDM,320,RC,73000,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,60.74,60.74,60.74,"1 through 10","percent of total billed charges","20.37% of total billed charges",217.53,56.5,,7.64,7.64,7.64,"1 through 10","percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR COCCYX OR SACRUM",4074430,CDM,320,RC,72220,HCPCS,OUTPATIENT,,,390,312,,331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",79.44,20.37,,63.53,63.53,63.53,"1 through 10","percent of total billed charges","20.37% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",220.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",219.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",351,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",267.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",226.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",79.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",331.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,351,
"XR CYSTOGRAM",4074455,CDM,320,RC,74430,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.08,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119.16,526.5,
"XR CYSTOURETHROGRAM",4073070,CDM,320,RC,74455,HCPCS,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",413.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",149.72,661.5,
"XR ELBOW AP LATERAL  LT",4000025,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,60.74,60.74,60.74,"1 through 10","percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,59.53,59.53,59.53,"1 through 10","percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,0.99,0.99,0.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR ELBOW AP LATERAL RT",4000018,CDM,320,RC,73070,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,60.74,60.74,60.74,"1 through 10","percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,59.53,59.53,59.53,"1 through 10","percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,0.99,0.99,0.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR ELBOW LEFT 3 VIEW",4073081,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",92.68,20.37,,6.00,5.15,6.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",257.08,56.5,,7.50,2.76,9.00,"1 through 10","percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",255.71,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,72.64,72.64,72.64,"1 through 10","percent of total billed charges","35% of total billed charges",312.59,68.7,,306.67,306.67,306.67,"1 through 10","percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,42.82,18.96,66.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,409.5,
"XR ELBOW RIGHT 3 VIEW",4073080,CDM,320,RC,73080,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",92.68,20.37,,6.00,5.15,6.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",257.08,56.5,,7.50,2.76,9.00,"1 through 10","percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",255.71,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,72.64,72.64,72.64,"1 through 10","percent of total billed charges","35% of total billed charges",312.59,68.7,,306.67,306.67,306.67,"1 through 10","percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,42.82,18.96,66.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,409.5,
"XR EXAM ENTIRE SPINE 2/3 VIEWS",4072082,CDM,320,RC,72082,HCPCS,OUTPATIENT,,,460,368,,391,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",93.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",259.9,56.5,,15.99,15.99,15.99,"1 through 10","percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",259.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",258.52,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",414,90,,,,,0,"percent of total billed charges","90% of total billed charges",161,35,,,,,0,"percent of total billed charges","35% of total billed charges",316.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",266.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",93.7,20.37,,13.92,13.92,13.92,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",391,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,414,
"XR EXTRA VIEWS",4070150,CDM,320,RC,76499,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.15,279,
"XR FACIAL BONES 4 VIEWS",4073551,CDM,320,RC,70150,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,95.30,95.30,95.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,93.40,93.40,93.40,"1 through 10","percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR FEMUR AP/LAT LT",4083550,CDM,320,RC,73552,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,70.99,70.99,70.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,9.23,4.20,64.06,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR FEMUR AP/LAT RT",4073550,CDM,320,RC,73552,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,70.99,70.99,70.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,9.23,4.20,64.06,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR FINGER 3 VIEWS LT",4083140,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,50.50,50.50,50.50,"1 through 10","percent of total billed charges","20.37% of total billed charges",175.15,56.5,,6.10,6.02,7.10,"1 through 10","percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.15,279,
"XR FINGER 3 VIEWS RT",4073140,CDM,320,RC,73140,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,50.50,50.50,50.50,"1 through 10","percent of total billed charges","20.37% of total billed charges",175.15,56.5,,6.10,6.02,7.10,"1 through 10","percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.15,279,
"XR FLURO GUIDANCE NEEDLE PLACEMENT",4076000,CDM,320,RC,77002,HCPCS,OUTPATIENT,,,1235,988,,1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",694.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",848.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",716.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.57,1111.5,
"XR FLUROSCOPY OF LARYNX",4076001,CDM,320,RC,70370,HCPCS,OUTPATIENT,,,1045,836,,888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",717.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",606.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,940.5,
"XR FLUROSCOPY PORTACATH INSERT",4077001,CDM,320,RC,77001,HCPCS,OUTPATIENT,,,870,696,,739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",217.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",217.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",491.55,56.5,,16.83,16.83,16.83,"1 through 10","percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.94,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",597.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",504.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",177.22,783,
"XR FLUROSCOPY/1HR",4070370,CDM,320,RC,76000,HCPCS,OUTPATIENT,,,1045,836,,888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",717.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",606.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,940.5,
"XR FOOT 3 VIEWS LT",4073630,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,31.26,12.52,50.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.99,7.06,57.69,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,293.19,293.19,293.19,"1 through 10","percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,36.58,10.28,62.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,12,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR FOOT 3 VIEWS RT",4000022,CDM,320,RC,73630,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,31.26,12.52,50.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.99,7.06,57.69,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,293.19,293.19,293.19,"1 through 10","percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,36.58,10.28,62.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,12,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR FOREARM AP/LAT LT",4073090,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,32.64,10.16,55.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",217.53,56.5,,7.00,6.66,8.17,"1 through 10","percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,59.53,59.53,59.53,"1 through 10","percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,61.47,61.47,61.47,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR FOREARM AP/LAT RT",4000003,CDM,320,RC,73090,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,32.64,10.16,55.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",217.53,56.5,,7.00,6.66,8.17,"1 through 10","percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,59.53,59.53,59.53,"1 through 10","percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,61.47,61.47,61.47,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR GASTRIC TUBE INJECTION",4076080,CDM,320,RC,49465,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.13,760.5,
"XR GI / AC",4007424,CDM,320,RC,74246,HCPCS,OUTPATIENT,,,1160,928,,986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",651.92,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1044,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,35,,,,,0,"percent of total billed charges","35% of total billed charges",796.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",672.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1044,
"XR GI BARIUM SWALLOW",4074246,CDM,320,RC,74220,HCPCS,OUTPATIENT,,,1675,1340,,1423.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",341.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",946.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",946.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",946.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",941.35,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1507.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",586.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1150.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",971.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",341.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1423.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1507.5,
"XR GI SINGLE CONTRAST",4074240,CDM,320,RC,74240,HCPCS,OUTPATIENT,,,1160,928,,986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",651.92,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1044,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,35,,,,,0,"percent of total billed charges","35% of total billed charges",796.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",672.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1044,
"XR GI W/SB SINGLE CONTRAST",4074245,CDM,320,RC,74240,HCPCS,OUTPATIENT,,,1160,928,,986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",651.92,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1044,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,35,,,,,0,"percent of total billed charges","35% of total billed charges",796.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",672.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1044,
"XR GI/AC W/SB",4074249,CDM,320,RC,74246,HCPCS,OUTPATIENT,,,1160,928,,986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",655.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",651.92,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1044,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,35,,,,,0,"percent of total billed charges","35% of total billed charges",796.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",672.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",236.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",986,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,1044,
"XR HAND 3 VIEWS LT",4083130,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,61.66,56.08,67.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.67,7.50,64.32,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,67.26,67.26,67.26,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,53.93,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR HAND 3 VIEWS RT",4073130,CDM,320,RC,73130,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,61.66,56.08,67.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.67,7.50,64.32,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,67.26,67.26,67.26,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,53.93,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR HIP AP/LATERAL LT",4083510,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,70.30,70.30,70.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,76.28,9.69,95.34,15,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,70.35,6.12,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,12,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR HIP AP/LATERAL RT",4073510,CDM,320,RC,73502,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,70.30,70.30,70.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,76.28,9.69,95.34,15,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,70.35,6.12,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,12,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR HIPS BIL WITH AP/PELVIS",4000016,CDM,320,RC,73521,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,11.98,11.98,11.98,"1 through 10","percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,92.00,92.00,92.00,"1 through 10","percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,2.01,2.01,2.01,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,535.5,
"XR HUMERUS AP/LATERAL LT",4083060,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,6.90,6.66,13.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR HUMERUS AP/LATERAL RT",4073060,CDM,320,RC,73060,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,6.90,6.66,13.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR HYSTERIOSALPINGOGRAM",4074740,CDM,320,RC,74740,HCPCS,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",413.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",149.72,661.5,
"XR INJECTION INTERMED JNT",4020605,CDM,320,RC,20605,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",407.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",147.68,652.5,
"XR INJECTION SINUS TRACT OR DRAIN",4049424,CDM,320,RC,49424,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",241.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",295.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,387,
"XR IVP",4074410,CDM,320,RC,74410,HCPCS,OUTPATIENT,,,970,776,,824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",197.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",545.14,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",873,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",666.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",562.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",197.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,873,
"XR JT INJ MAJOR BURSA LT",4020610,CDM,320,RC,20610,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,210.31,210.31,210.31,"1 through 10","fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",203.7,900,
"XR JT INJ MAJOR BURSA RT",4000028,CDM,320,RC,20610,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,210.31,210.31,210.31,"1 through 10","fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",203.7,900,
"XR KIDIGRAM",4070610,CDM,320,RC,76010,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR KIDIGRAM",4076010,CDM,320,RC,76010,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",216.37,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,346.5,
"XR KNEE  COMPLETE LT",4083564,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,9.89,3.63,75.82,"1 through 10","percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,91.90,90.70,93.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR KNEE COMPLETE RT",4003564,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,9.89,3.63,75.82,"1 through 10","percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,91.90,90.70,93.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR KNEE LTD AP/LATERAL LT",4083560,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,73.30,73.30,73.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,30.95,7.40,54.49,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,26.00,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR KNEE LTD AP/LATERAL RT",4073560,CDM,320,RC,73560,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,73.30,73.30,73.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,30.95,7.40,54.49,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,26.00,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR KNEE MINIMUM 3 VWS LT",4083562,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",107.96,20.37,,67.49,54.80,80.17,"1 through 10","percent of total billed charges","20.37% of total billed charges",299.45,56.5,,17.19,4.66,81.63,17,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.5,35,,84.61,84.61,84.61,"1 through 10","percent of total billed charges","35% of total billed charges",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",107.96,20.37,,13.16,12.58,70.32,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,14,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,477,
"XR KNEE MINIMUM 3 VWS RT",4073562,CDM,320,RC,73562,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",107.96,20.37,,67.49,54.80,80.17,"1 through 10","percent of total billed charges","20.37% of total billed charges",299.45,56.5,,17.19,4.66,81.63,17,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",299.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",297.86,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.5,35,,84.61,84.61,84.61,"1 through 10","percent of total billed charges","35% of total billed charges",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",107.96,20.37,,13.16,12.58,70.32,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,14,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,477,
"XR KNEES AP  STANDING",4073565,CDM,320,RC,73565,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR LEG LOWER AP/LAT LT",4083590,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,28.32,6.36,49.54,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,67.26,67.26,67.26,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR LEG LOWER AP/LAT RT",4073590,CDM,320,RC,73590,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,28.32,6.36,49.54,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,67.26,67.26,67.26,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR LOWER EXTRMITY TOTAL LT",4083592,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR LOWER EXTRMITY TOTAL RT",4073592,CDM,320,RC,73592,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR MANDIBLE 4 VIEWS COMPLETE",4070110,CDM,320,RC,70110,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR MANDIBLE/LTD LESS 4 VIEWS",4070100,CDM,320,RC,70100,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR MYELO CERVICAL",4072240,CDM,320,RC,72240,HCPCS,OUTPATIENT,,,1665,1332,,1415.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",933.34,130,,,,,0,"fee schedule","130% of CMS OPPS rate",339.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",935.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",732.31,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1498.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",582.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1143.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.16,90,,,,,0,"fee schedule","90% of CMS OPPS rate",965.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",339.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1415.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",339.16,1498.5,
"XR MYELO LUMBAR",4072265,CDM,320,RC,72265,HCPCS,OUTPATIENT,,,1665,1332,,1415.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",933.34,130,,,,,0,"fee schedule","130% of CMS OPPS rate",339.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",935.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",732.31,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1498.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",582.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1143.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.16,90,,,,,0,"fee schedule","90% of CMS OPPS rate",965.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",339.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1415.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",339.16,1498.5,
"XR MYELO THORACIC",4072255,CDM,320,RC,72255,HCPCS,OUTPATIENT,,,1665,1332,,1415.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",933.34,130,,,,,0,"fee schedule","130% of CMS OPPS rate",339.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",940.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",935.73,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",732.31,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1498.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",582.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1143.86,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.16,90,,,,,0,"fee schedule","90% of CMS OPPS rate",965.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",339.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1415.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",339.16,1498.5,
"XR NASAL BONES 3 VIEWS",4070160,CDM,320,RC,70160,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,405,
"XR NECK SOFT TISSUE",4070360,CDM,320,RC,70360,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",68.24,20.37,,52.85,52.85,52.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",188.27,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",68.24,301.5,
"XR OPER CHOLANGI 2ND SET FILMS",4074301,CDM,320,RC,74301,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"XR OPER CHOLANGIOGRAM",4074300,CDM,320,RC,74300,HCPCS,OUTPATIENT,,,1005,804,,854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",204.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",564.81,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",351.75,35,,160.45,160.45,160.45,"1 through 10","percent of total billed charges","35% of total billed charges",690.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",582.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",204.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",204.72,904.5,
"XR ORBITS 4 VIEWS",4070200,CDM,320,RC,70200,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR OSCALSIS HEEL AP/LAT LT",4083650,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR OSCALSIS HEEL AP/LAT RT",4073650,CDM,320,RC,73650,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR PATELLA/TUNNEL 4 VW RT",4073564,CDM,320,RC,73564,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,9.89,3.63,75.82,"1 through 10","percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,91.90,90.70,93.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR PELVIS/AP",4072170,CDM,320,RC,72170,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,7.96,7.96,7.96,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,293.19,293.19,293.19,"1 through 10","percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,391.5,
"XR PELVIS/BOTH OBLIQUES 3 VW",4072190,CDM,320,RC,72190,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,8.87,8.87,8.87,"1 through 10","percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR RETROGRADE IVP",4074420,CDM,320,RC,74420,HCPCS,OUTPATIENT,,,1510,1208,,1283.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",307.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",848.62,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1359,90,,,,,0,"percent of total billed charges","90% of total billed charges",528.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1037.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",875.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",307.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1283.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,1359,
"XR RIBS BILAT W PA CHEST 4 VIEWS",4071111,CDM,320,RC,71111,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,135.80,135.80,135.80,"1 through 10","percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,172.43,172.43,172.43,"1 through 10","percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,972,
"XR RIBS BILAT W/O CHEST  3 VIEWS",4071110,CDM,320,RC,71110,HCPCS,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",494.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,,,,0,"percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,792,
"XR RIBS LT/PA CHEST UNILAT",4071102,CDM,320,RC,71101,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",121.2,20.37,,12.24,12.24,12.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",336.18,56.5,,43.70,11.71,75.63,"1 through 10","percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,66.19,43.13,89.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,535.5,
"XR RIBS UNILAT LEFT W PA CHEST",4081101,CDM,320,RC,71101,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",121.2,20.37,,12.24,12.24,12.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",336.18,56.5,,43.70,11.71,75.63,"1 through 10","percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,66.19,43.13,89.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,535.5,
"XR RIBS UNILAT LEFT W/O PA CHEST  2 VIEW",4071100,CDM,320,RC,71100,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,9.85,9.85,9.85,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,62.46,62.46,62.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,369,
"XR RIBS UNILAT RT W PA CHEST",4071101,CDM,320,RC,71101,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",121.2,20.37,,12.24,12.24,12.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",336.18,56.5,,43.70,11.71,75.63,"1 through 10","percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,66.19,43.13,89.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,535.5,
"XR RIBS UNILAT RT W/O PA CHEST  2 VIEW",4081100,CDM,320,RC,71100,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,9.85,9.85,9.85,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,62.46,62.46,62.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,369,
"XR SACROILLIAC JOINTS 3 VIEW",4072202,CDM,320,RC,72202,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.57,382.5,
"XR SCAPULA LT",4083010,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,391.5,
"XR SCAPULA RT",4073010,CDM,320,RC,73010,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,391.5,
"XR SCOLIOSIS SURVEY",4072090,CDM,320,RC,72082,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",316.4,56.5,,15.99,15.99,15.99,"1 through 10","percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,,,,0,"percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,13.92,13.92,13.92,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,504,
"XR SHOULDER 2-3 VIEWS LT",4083030,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,68.63,68.63,68.63,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.59,6.27,63.56,13,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,293.19,293.19,293.19,"1 through 10","percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,66.44,41.35,69.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,28,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR SHOULDER 2-3 VIEWS RT",4073030,CDM,320,RC,73030,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,68.63,68.63,68.63,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.59,6.27,63.56,13,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,293.19,293.19,293.19,"1 through 10","percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,66.44,41.35,69.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,28,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR SINUSES 4 VIEWS",4070220,CDM,320,RC,70220,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,95.30,95.30,95.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,526.5,
"XR SKULL 4 VIEWS",4070260,CDM,320,RC,70260,HCPCS,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.92,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,594,
"XR SKULL/LTD 2 VIEWS",4070250,CDM,320,RC,70250,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,526.5,
"XR SMALL BOWEL",4074250,CDM,320,RC,74250,HCPCS,OUTPATIENT,,,825,660,,701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",168.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.65,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",742.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",288.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",566.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",478.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",168.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,742.5,
"XR SPINE CERVICAL LTD",4072040,CDM,320,RC,72040,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,16.00,16.00,16.00,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR SPINE SINGLE VIEW",4072020,CDM,320,RC,72020,HCPCS,OUTPATIENT,,,365,292,,310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",74.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",206.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",205.13,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",328.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",250.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",211.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",74.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,328.5,
"XR SPINE THORACIC 2 VIEWS",4072070,CDM,320,RC,72070,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",114.07,20.37,,6.32,6.32,6.32,"1 through 10","percent of total billed charges","20.37% of total billed charges",316.4,56.5,,8.94,8.77,9.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,89.40,89.40,89.40,"1 through 10","percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,1.82,1.82,1.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,504,
"XR SPINE THORACIC 4 VIEWS",4072074,CDM,320,RC,72074,HCPCS,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,616.5,
"XR SPINE/CER SP WITH FLEX & EXT",4072052,CDM,320,RC,72052,HCPCS,OUTPATIENT,,,825,660,,701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",168.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",466.13,56.5,,98.20,98.20,98.20,"1 through 10","percent of total billed charges","50.56% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",466.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.65,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",742.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",288.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",566.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",478.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",168.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,742.5,
"XR SPINE/CERVICAL 5 VIEWS",4072050,CDM,320,RC,72050,HCPCS,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",139.53,20.37,,58.38,18.63,98.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",387.03,56.5,,11.69,4.96,98.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,105.92,105.92,105.92,"1 through 10","percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,11,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,616.5,
"XR SPINE/LUMBAR",4072110,CDM,320,RC,72110,HCPCS,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",139.53,20.37,,12.68,9.34,80.36,"1 through 10","percent of total billed charges","20.37% of total billed charges",387.03,56.5,,81.07,11.68,101.72,"1 through 10","percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,109.36,109.36,109.36,"1 through 10","percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,44.18,75.76,22,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,616.5,
"XR SPINE/LUMBAR  W/FLEX EXT",4072114,CDM,320,RC,72114,HCPCS,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",387.03,56.5,,14.43,13.10,15.28,"1 through 10","percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,109.36,109.36,109.36,"1 through 10","percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,616.5,
"XR SPINE/LUMBAR FLEX EX ONLY",4072120,CDM,320,RC,72120,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",114.07,20.37,,91.23,91.23,91.23,"1 through 10","percent of total billed charges","20.37% of total billed charges",316.4,56.5,,11.35,11.35,11.35,"1 through 10","percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,,,,0,"percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,504,
"XR SPINE/LUMBAR LTD",4072100,CDM,320,RC,72100,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",316.4,56.5,,39.58,13.74,78.05,"1 through 10","percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",314.72,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,89.40,89.40,89.40,"1 through 10","percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,50.02,18.51,81.52,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,51.32,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,504,
"XR STERNO/CLAV JTS 3 VIEWS",4071130,CDM,320,RC,71130,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",289.43,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,463.5,
"XR STERNUM-AP/LAT/OBLIQUES",4071120,CDM,320,RC,71120,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,8.39,8.39,8.39,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,39.27,15.13,63.41,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR T-M JOINTS TOMO/BILATERAL",4070330,CDM,320,RC,70330,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,490.5,
"XR TOE AP AND LATERAL LT",4083660,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,48.90,48.90,48.90,"1 through 10","percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,47.93,47.93,47.93,"1 through 10","percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.15,279,
"XR TOE AP AND LATERAL RT",4073660,CDM,320,RC,73660,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,48.90,48.90,48.90,"1 through 10","percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,47.93,47.93,47.93,"1 through 10","percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.15,279,
"XR TOTAL EXTRMITY UPPER LT",4083092,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,391.5,
"XR TOTAL EXTRMITY UPPER RT",4073092,CDM,320,RC,73092,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,391.5,
"XR VENOGRAM LT",4085820,CDM,320,RC,75820,HCPCS,OUTPATIENT,,,2180,1744,,1853,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1835.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",444.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1231.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1231.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1231.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1225.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",1439.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1962,90,,,,,0,"percent of total billed charges","90% of total billed charges",763,35,,,,,0,"percent of total billed charges","35% of total billed charges",1497.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1270.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1264.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",444.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1853,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",444.07,1962,
"XR VENOGRAM RT",4075820,CDM,320,RC,75820,HCPCS,OUTPATIENT,,,2180,1744,,1853,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1835.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",444.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1231.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1231.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1231.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1225.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",1439.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1962,90,,,,,0,"percent of total billed charges","90% of total billed charges",763,35,,,,,0,"percent of total billed charges","35% of total billed charges",1497.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1270.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1264.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",444.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1853,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",444.07,1962,
"XR WRIST 3 VIEWS LT",4083110,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,37.90,11.53,64.27,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,9.37,6.45,63.14,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,66.44,66.44,68.84,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,21.53,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR WRIST 3 VIEWS RT",4073110,CDM,320,RC,73110,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,37.90,11.53,64.27,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,9.37,6.45,63.14,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",244.47,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,66.44,66.44,68.84,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,21.53,62.73,"1 through 10","fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,391.5,
"XR XRAY OF MAMMARY DUCT",4077053,CDM,320,RC,77053,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",421.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,675,
"XR ARTHROGRAM SHOULDER",4073040,CDM,322,RC,73040,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.08,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",220,972,
"XR INJECTION SHOULDER ARTHROGRAM",4023350,CDM,322,RC,23350,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",230.42,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"THORACENTESIS FOR ASPIRATION",4032421,CDM,324,RC,32555,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",730.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",407.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",573.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",147.68,730.38,
"THORACENTESIS W/ TUBE INSERT",4032422,CDM,324,RC,32555,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",730.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",407.45,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",573.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",147.68,730.38,
"XR CHEST AND LORDOTIC",4071021,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,526.5,
"XR CHEST AND OBLIQUES",4071022,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,505,404,,429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",283.81,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",454.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",292.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,454.5,
"XR CHEST AP PORTABLE",407101,CDM,324,RC,71045,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",77.41,20.37,,47.78,18.79,62.98,"1 through 10","percent of total billed charges","20.37% of total billed charges",214.7,56.5,,34.71,8.06,79.19,14,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",133,35,,58.76,58.76,58.76,"1 through 10","percent of total billed charges","35% of total billed charges",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",77.41,20.37,,60.67,44.40,60.67,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,104,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,342,
"XR CHEST DECUBUTIS",4071035,CDM,324,RC,71046,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.57,20.37,,56.58,16.87,68.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",240.13,56.5,,9.89,9.29,60.21,22,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",238.85,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,43.54,3.85,71.85,12,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,89,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,382.5,
"XR CHEST FLUOROSCOPY",4071023,CDM,324,RC,71046,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",138.52,20.37,,56.58,16.87,68.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",384.2,56.5,,9.89,9.29,60.21,22,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,43.54,3.85,71.85,12,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,89,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,612,
"XR CHEST PA / LAT + EXPIRATION",4007102,CDM,324,RC,71047,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",168,35,,,,,0,"percent of total billed charges","35% of total billed charges",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,432,
"XR CHEST PA LAT",4071020,CDM,324,RC,71046,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,56.58,16.87,68.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,9.89,9.29,60.21,22,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,69.58,69.58,69.58,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,43.54,3.85,71.85,12,"percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,89,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,405,
"XR CHEST PA OR 1 VIEW",4071010,CDM,324,RC,71045,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",77.41,20.37,,47.78,18.79,62.98,"1 through 10","percent of total billed charges","20.37% of total billed charges",214.7,56.5,,34.71,8.06,79.19,14,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",214.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",213.56,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",133,35,,58.76,58.76,58.76,"1 through 10","percent of total billed charges","35% of total billed charges",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",77.41,20.37,,60.67,44.40,60.67,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,104,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,342,
"XR INJECTION PROCEDURE FOR  SIALOGRAPHY",4042550,CDM,324,RC,42550,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",328.77,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",119.16,526.5,
"XR SIALOGRAPHY",4070390,CDM,324,RC,70390,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",271.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",269.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",168,35,,,,,0,"percent of total billed charges","35% of total billed charges",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",97.78,432,
"NM GASTRIC EMPTYING",4578264,CDM,341,RC,78264,HCPCS,OUTPATIENT,,,1925,1540,,1636.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",392.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",673.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1322.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1116.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",392.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1636.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,1732.5,
"NM HIDA W/O EJECTION FRACTION",4578226,CDM,341,RC,78226,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",231.2,1021.5,
"NM HIDA WITH EJECTION FRACTION",4578227,CDM,341,RC,78227,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",498.92,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",440.23,90,,,,,0,"fee schedule","90% of CMS OPPS rate",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",231.2,1021.5,
"NM I 123 THYROID MULTIDETECT",4578007,CDM,341,RC,78012,HCPCS,OUTPATIENT,,,1560,1248,,1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",317.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",881.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1404,90,,,,,0,"percent of total billed charges","90% of total billed charges",546,35,,,,,0,"percent of total billed charges","35% of total billed charges",1071.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",904.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",317.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1326,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",317.77,1404,
"NM INTESTINE IMAGING",4578290,CDM,341,RC,78290,HCPCS,OUTPATIENT,,,1925,1540,,1636.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",392.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1087.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",673.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1322.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1116.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",392.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1636.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,1732.5,
"NM LIVER/SPLEEN (NO SPECT)",4578215,CDM,341,RC,78215,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",203.7,900,
"NM LTD AREA BONE SCAN",4578300,CDM,341,RC,78300,HCPCS,OUTPATIENT,,,1185,948,,1007.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",241.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",669.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",669.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",669.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",669.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1066.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",414.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",814.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",687.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",241.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1007.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.38,1066.5,
"NM MUGA",4578481,CDM,341,RC,78481,HCPCS,OUTPATIENT,,,1510,1208,,1283.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",307.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",853.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",498.92,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1359,90,,,,,0,"percent of total billed charges","90% of total billed charges",528.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1037.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",440.23,90,,,,,0,"fee schedule","90% of CMS OPPS rate",875.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",307.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1283.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",307.59,1359,
"NM MYOCARDIAL PER W/WALL MOT",4578478,CDM,341,RC,78452,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1542.24,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",1210.06,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1067.7,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165,1542.24,
"NM MYOCARDIAL PERFUSION STUDY W/EF",4578480,CDM,341,RC,78452,HCPCS,OUTPATIENT,,,4870,3896,,4139.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1542.24,130,,,,,0,"fee schedule","130% of CMS OPPS rate",992.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1210.06,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4383,90,,,,,0,"percent of total billed charges","90% of total billed charges",1704.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3345.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1067.7,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2824.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",992.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4139.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",992.02,4383,
"NM MYOCARDIAL SPECT SINGLE S",4578464,CDM,341,RC,78451,HCPCS,OUTPATIENT,,,3120,2496,,2652,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1542.24,130,,,,,0,"fee schedule","130% of CMS OPPS rate",635.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",1210.06,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2808,90,,,,,0,"percent of total billed charges","90% of total billed charges",1092,35,,,,,0,"percent of total billed charges","35% of total billed charges",2143.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1067.7,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1809.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",635.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2652,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.54,2808,
"NM PARATHYROID",4578070,CDM,341,RC,78070,HCPCS,OUTPATIENT,,,840,672,,714,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",294,35,,,,,0,"percent of total billed charges","35% of total billed charges",577.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",487.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",714,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",171.11,756,
"NM PULMONARY PERFUSION",4578580,CDM,341,RC,78580,HCPCS,OUTPATIENT,,,1145,916,,973.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",233.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",646.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",646.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",646.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",646.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1030.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",400.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",786.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",664.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",233.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",973.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.24,1030.5,
"NM PULMONARY VENTILATION SCAN",4578587,CDM,341,RC,78579,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.31,805.5,
"NM PULMONARY VENTILATION/PERFUSION",4578582,CDM,341,RC,78582,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",498.92,102,,,,,0,"fee schedule","102% of CMS OPPS rate",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",440.23,90,,,,,0,"fee schedule","90% of CMS OPPS rate",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.31,805.5,
"NM RENAL SCAN",4578707,CDM,341,RC,78707,HCPCS,OUTPATIENT,,,1755,1404,,1491.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",357.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",991.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",991.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",991.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",991.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",498.92,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1579.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",614.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1205.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",440.23,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1017.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",357.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1491.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.49,1579.5,
"NM RENAL SCAN W/CAPTOPRIL",4578709,CDM,341,RC,78709,HCPCS,OUTPATIENT,,,1970,1576,,1674.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",401.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1113.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1113.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1113.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1113.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",498.92,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1773,90,,,,,0,"percent of total billed charges","90% of total billed charges",689.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1353.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",440.23,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1142.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",401.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1674.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",489.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",401.29,1773,
"NM SPECT MS R/S/R W/WO QUANT",4578465,CDM,341,RC,78452,HCPCS,OUTPATIENT,,,3120,2496,,2652,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1542.24,130,,,,,0,"fee schedule","130% of CMS OPPS rate",635.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",1210.06,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2808,90,,,,,0,"percent of total billed charges","90% of total billed charges",1092,35,,,,,0,"percent of total billed charges","35% of total billed charges",2143.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1067.7,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1809.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",635.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2652,85,,,,,0,"percent of total billed charges","85% of total billed charges",1186.33,100,,,,,0,"fee schedule","100% of CMS OPPS rate",635.54,2808,
"NM TC04 TECHNETATE",4500014,CDM,341,RC,A9500,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NM TESTICULAR SCAN",4578761,CDM,341,RC,78761,HCPCS,OUTPATIENT,,,1020,816,,867,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",918,90,,,,,0,"percent of total billed charges","90% of total billed charges",357,35,,,,,0,"percent of total billed charges","35% of total billed charges",700.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",591.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",867,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",207.77,918,
"NM THREE PHASE BONE SCAN",4578315,CDM,341,RC,78315,HCPCS,OUTPATIENT,,,1985,1588,,1687.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",404.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1786.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",694.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1363.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1151.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",404.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1687.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,1786.5,
"NM THYROID IMAGING ONLY",4578010,CDM,341,RC,78013,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
"NM THYROID IMAGING W/UPTAKE",4578014,CDM,341,RC,78014,HCPCS,OUTPATIENT,,,1625,1300,,1381.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",331.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",918.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",918.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",918.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",918.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1462.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",568.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1116.38,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",942.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",331.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1381.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,1462.5,
"NM WHOLE BODY BONE SCAN",4578306,CDM,341,RC,78306,HCPCS,OUTPATIENT,,,1950,1560,,1657.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.69,130,,,,,0,"fee schedule","130% of CMS OPPS rate",397.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1101.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1101.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1101.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1101.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",372.45,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1755,90,,,,,0,"percent of total billed charges","90% of total billed charges",682.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1339.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1131,58,,,,,0,"percent of total billed charges","58% of total billed charges",397.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1657.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.16,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.63,1755,
"NM I 123 CAPSULE 200 PER UCI",4500018,CDM,343,RC,A9516,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"NM TC99M CARDIOLITE",4500013,CDM,343,RC,A9500,HCPCS,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"NM TC99M CHOLETEC (MEBROFENIN)",4500011,CDM,343,RC,A9537,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,,,,0,"percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,288,
"NM TC99M DTPA",4500006,CDM,343,RC,A9539,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NM TC99M HEPATOLITE",4500034,CDM,343,RC,A9510,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"NM TC99M MAA  10 MCI",4500007,CDM,343,RC,A9540,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"NM TC99M SULFUR COLLOID",4500036,CDM,343,RC,A9541,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"CT 3-D RECON AT CT",4275377,CDM,350,RC,76376,HCPCS,OUTPATIENT,,,980,784,,833,85,,,,,0,"percent of total billed charges","85% of total billed charges",245,25,,,,,0,"percent of total billed charges","25% of total billed charges",245,25,,,,,0,"percent of total billed charges","25% of total billed charges",245,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",550.76,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",882,90,,,,,0,"percent of total billed charges","90% of total billed charges",343,35,,,,,0,"percent of total billed charges","35% of total billed charges",673.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",882,90,,,,,0,"percent of total billed charges","90% of total billed charges",568.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",833,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",199.63,882,
"CT LIMITED/LOCALIZED STUD",4276380,CDM,350,RC,76380,HCPCS,OUTPATIENT,,,3040,2432,,2584,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",619.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1717.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1717.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1717.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1708.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2736,90,,,,,0,"percent of total billed charges","90% of total billed charges",1064,35,,,,,0,"percent of total billed charges","35% of total billed charges",2088.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1763.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",619.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2584,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,2736,
"CT NEEDLE BIOPSY/JT INJECT",4276360,CDM,350,RC,77012,HCPCS,OUTPATIENT,,,4525,3620,,3846.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",921.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2556.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2556.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2556.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2543.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",4072.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1583.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3108.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4072.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2624.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",921.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3846.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",921.74,4072.5,
"CT UNLISTED DIAG CT PROCEDUR",4276497,CDM,350,RC,76497,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,2983.5,
"CTA CHEST/THORAX W/WO",4271275,CDM,350,RC,71275,HCPCS,OUTPATIENT,,,4080,3264,,3468,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",831.1,20.37,,512.97,512.97,512.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",2305.2,56.5,,79.45,75.26,190.88,"1 through 10","percent of total billed charges","50.56% of total billed charges",2305.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2305.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2292.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3672,90,,,,,0,"percent of total billed charges","90% of total billed charges",1428,35,,242.04,103.52,380.55,"1 through 10","percent of total billed charges","35% of total billed charges",2802.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2366.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",831.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,309.99,26,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3468,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3672,
"CTA HEAD W/WO",4270496,CDM,350,RC,70496,HCPCS,OUTPATIENT,,,4110,3288,,3493.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",837.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2322.15,56.5,,382.35,122.85,403.78,"1 through 10","percent of total billed charges","50.56% of total billed charges",2322.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2322.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2309.82,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3699,90,,,,,0,"percent of total billed charges","90% of total billed charges",1438.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2823.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2383.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",837.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,309.99,181.77,309.99,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3493.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3699,
"CTA PELVIS W/WO",4272191,CDM,350,RC,72191,HCPCS,OUTPATIENT,,,3965,3172,,3370.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",807.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2240.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2240.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2240.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2228.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3568.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1387.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2723.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2299.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",807.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3370.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3568.5,
"CT HEAD W & W/O CONTRAST",4270470,CDM,351,RC,70470,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,65.01,53.69,76.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,103.42,200.09,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT HEAD WITH CONTRAST",4270460,CDM,351,RC,70460,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,160.12,160.12,160.12,"1 through 10","percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT HEAD WITHOUT CONTRAST",4270450,CDM,351,RC,70450,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,436.72,354.09,519.34,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,38.58,32.82,87.95,16,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,399.12,308.37,489.87,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,1616.07,1616.07,1616.07,"1 through 10","percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,68.49,68.49,68.49,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,159.98,100,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT MAXILLO FACIAL AREA W/O",4270486,CDM,351,RC,70486,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,469.87,427.40,512.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,44.95,24.45,156.65,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,529.25,529.25,529.25,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,529.25,529.25,529.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,12,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT MAXILLO FACIAL AREA W/WO",4270488,CDM,351,RC,70488,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT MAXILLO FACIAL AREA WITH",4270487,CDM,351,RC,70487,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,336.95,336.95,336.95,"1 through 10","percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,47.38,47.38,47.38,"1 through 10","percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT ORBITS W/O",4270480,CDM,351,RC,70480,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,428.19,352.38,504.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT ORBITS W/WO",4270482,CDM,351,RC,70482,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT ORBITS WITH",4270481,CDM,351,RC,70481,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT SOFT TISSUE NECK W",4270491,CDM,351,RC,70491,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,69.07,69.07,69.07,"1 through 10","percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,255.04,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT SOFT TISSUE NECK W/WO",4270492,CDM,351,RC,70492,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,67.74,39.44,69.61,"1 through 10","percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT SOFT TISSUE NECK WO",4270490,CDM,351,RC,70490,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,63.93,45.18,66.77,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,55.87,55.87,55.87,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CTA NECK W/WO",4270498,CDM,351,RC,70498,HCPCS,OUTPATIENT,,,4195,3356,,3565.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",854.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2370.18,56.5,,32.36,5.90,197.07,"1 through 10","percent of total billed charges","50.56% of total billed charges",2370.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2370.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2357.59,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3775.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1468.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2881.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2433.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",854.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3565.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3775.5,
"CT 3-D IND/WK STATION",4273705,CDM,352,RC,76377,HCPCS,OUTPATIENT,,,1045,836,,888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",261.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",261.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",261.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",717.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",606.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",212.87,940.5,
"CT ABD W & W/O CONTRAST",4274170,CDM,352,RC,74170,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,592.39,592.39,592.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,69.57,69.57,69.57,"1 through 10","percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT ABD W/CONTRAST",4274150,CDM,352,RC,74160,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,61.53,61.53,61.53,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT ABD W/O CONT",4274151,CDM,352,RC,74150,HCPCS,OUTPATIENT,,,3345,2676,,2843.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",681.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1889.93,56.5,,73.80,47.74,99.86,"1 through 10","percent of total billed charges","50.56% of total billed charges",1889.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1889.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1879.89,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3010.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1170.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2298.02,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1940.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",681.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2843.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,3010.5,
"CT ABDOMEN/ PELVIS W & W/O CON",4274178,CDM,352,RC,74178,HCPCS,OUTPATIENT,,,7305,5844,,6209.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1488.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",4127.33,56.5,,96.37,60.20,639.93,"1 through 10","percent of total billed charges","50.56% of total billed charges",4127.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",4127.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",4105.41,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6574.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2556.75,35,,1166.26,1166.26,1166.26,"1 through 10","percent of total billed charges","35% of total billed charges",5018.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4236.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1488.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,177.39,254.44,12,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6209.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6574.5,
"CT ABDOMEN/PELVIS W/CONTRAST",4274177,CDM,352,RC,74177,HCPCS,OUTPATIENT,,,6695,5356,,5690.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1363.77,20.37,,568.98,151.68,986.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",3782.68,56.5,,95.54,76.43,555.51,23,"percent of total billed charges","50.56% of total billed charges",3782.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3782.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3762.59,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6025.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2343.25,35,,1068.88,1068.88,1068.88,"1 through 10","percent of total billed charges","35% of total billed charges",4599.47,68.7,,2611.06,2611.06,2611.06,"1 through 10","percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3883.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1363.77,20.37,,28.69,22.71,49.59,"1 through 10","percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,254.44,52,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5690.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6025.5,
"CT ABDOMEN/PELVIS W/O CONTRAST",4274176,CDM,352,RC,74176,HCPCS,OUTPATIENT,,,6640,5312,,5644,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1352.57,20.37,,939.65,855.79,1023.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",3751.6,56.5,,91.44,20.75,217.24,12,"percent of total billed charges","50.56% of total billed charges",3751.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3751.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3731.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5976,90,,,,,0,"percent of total billed charges","90% of total billed charges",2324,35,,628.66,310.24,947.07,"1 through 10","percent of total billed charges","35% of total billed charges",4561.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3851.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1352.57,20.37,,106.81,46.22,869.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,36,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5644,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,5976,
"CT CERVICAL SPINE W/CONTRAST",4272126,CDM,352,RC,72126,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,3015,
"CT CERVICAL SPINE W/OUT CONTRAST",4272125,CDM,352,RC,72125,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,522.95,522.95,522.95,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,41.28,17.98,128.25,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,512.56,512.56,512.56,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,529.25,529.25,529.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,151.56,12,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT CERVICAL SPINE W/WO",4272127,CDM,352,RC,72127,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT CHEST W/CONTRAST",4200002,CDM,352,RC,71260,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,379.07,345.37,412.77,"1 through 10","percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,58.39,40.41,153.53,"1 through 10","percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,534.84,534.84,534.84,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,309.99,126.82,309.99,13,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT CHEST W/O",4200001,CDM,352,RC,71250,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,469.87,427.40,512.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,56.99,43.11,173.62,19,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,512.56,512.56,512.56,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,16.33,13.67,529.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,159.98,62,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT DORSAL SPINE",4273704,CDM,352,RC,72130,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT DORSAL SPINE W/CON",4200013,CDM,352,RC,72129,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT DORSAL SPINE W/WO CONTRAST",4272120,CDM,352,RC,72130,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT DORSAL SPN W/O CONTRAS",4200012,CDM,352,RC,72128,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,41.04,41.04,41.04,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,529.25,529.25,529.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT LOWER EXT W/CONT-RIGHT",4273701,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,169.86,169.86,169.86,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT LOWER EXT W/CONTR-LEFT",4200008,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,169.86,169.86,169.86,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT LOWER EXT W/O CONTRAST LEFT",4272122,CDM,352,RC,73701,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,169.86,169.86,169.86,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT LOWER EXT W/WO LEFT",4200009,CDM,352,RC,73702,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT LOWER EXT W/WO RIGHT",4273702,CDM,352,RC,73702,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT LOWER EXTREM W/O CON LT",4272703,CDM,352,RC,73700,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,49.70,44.07,66.90,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,143.14,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT LOWER EXTREM W/O CON RT",4273700,CDM,352,RC,73700,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,49.70,44.07,66.90,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,143.14,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT LUMBAR SPINE W/CONTRAST",4272132,CDM,352,RC,72132,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,3015,
"CT LUMBAR SPINE W/O CON",4272131,CDM,352,RC,72131,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,87.72,43.62,131.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,327.70,179.81,475.59,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,211.30,199.78,222.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,159.98,20,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT LUMBAR SPINE W/WO",4272133,CDM,352,RC,72133,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT PELVIS W & W/O CON",4272194,CDM,352,RC,72194,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT PELVIS W/CONTRAST",4272193,CDM,352,RC,72193,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,40.25,40.25,40.25,"1 through 10","percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT PELVIS W/O CONTRAST",4272192,CDM,352,RC,72192,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,9.64,9.64,9.64,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,512.56,512.56,512.56,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,36.09,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT THORACIC SPINE W/O",4272128,CDM,352,RC,72128,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,41.04,41.04,41.04,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,529.25,529.25,529.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT THORACIC SPINE W/WO",4272130,CDM,352,RC,72130,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT THORACIC SPINE WITH",4272129,CDM,352,RC,72129,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT THORAX W/CONTRAST",4271260,CDM,352,RC,71260,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,379.07,345.37,412.77,"1 through 10","percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,58.39,40.41,153.53,"1 through 10","percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,534.84,534.84,534.84,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,309.99,126.82,309.99,13,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3015,
"CT THORAX W/O CONTRAST",4271250,CDM,352,RC,71250,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,469.87,427.40,512.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,56.99,43.11,173.62,19,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,512.56,512.56,512.56,"1 through 10","percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,16.33,13.67,529.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,159.98,62,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT THORAX W/OUT CONTRAST",4271270,CDM,352,RC,71270,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,84.63,60.41,108.84,"1 through 10","percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,565.13,565.13,565.13,"1 through 10","percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,65.51,65.51,65.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT THORAX W/WO CONTRAST",4200004,CDM,352,RC,71270,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,84.63,60.41,108.84,"1 through 10","percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,565.13,565.13,565.13,"1 through 10","percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,65.51,65.51,65.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT UPPER EXT W&W/O-RIGHT",4273202,CDM,352,RC,73202,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CT UPPER EXT W/CONT-LEFT",4200006,CDM,352,RC,73201,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,71.88,71.88,71.88,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,3015,
"CT UPPER EXT W/CONT-RIGHT",4273201,CDM,352,RC,73201,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1882.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,71.88,71.88,71.88,"1 through 10","percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,3015,
"CT UPPER EXT W/O-LEFT",4200005,CDM,352,RC,73200,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,67.28,47.26,87.30,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT UPPER EXT W/O-RIGHT",4273200,CDM,352,RC,73200,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,67.28,47.26,87.30,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1863.03,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,2983.5,
"CT UPPER EXT W/WO LEFT",4200007,CDM,352,RC,73202,HCPCS,OUTPATIENT,,,3655,2924,,3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2065.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2054.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3289.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1279.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2510.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2119.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",744.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3106.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3289.5,
"CTA ABDOMEN AND PELVIS",4274174,CDM,352,RC,74174,HCPCS,OUTPATIENT,,,4930,3944,,4190.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1004.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2785.45,56.5,,95.93,95.93,95.93,"1 through 10","percent of total billed charges","50.56% of total billed charges",2785.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2785.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2770.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4437,90,,,,,0,"percent of total billed charges","90% of total billed charges",1725.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3386.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2859.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1004.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,254.44,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4190.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4437,
"CTA ABDOMEN W/WO",4274175,CDM,352,RC,74175,HCPCS,OUTPATIENT,,,4035,3228,,3429.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",821.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2279.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2279.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2279.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2267.67,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3631.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1412.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2772.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2340.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",821.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3429.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3631.5,
"CTA AORTA W/RUNOFF W/WO",4275635,CDM,352,RC,75635,HCPCS,OUTPATIENT,,,5625,4500,,4781.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1145.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3178.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3178.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3178.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3161.25,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5062.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1968.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3864.38,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3262.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1145.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,126.82,126.82,126.82,"1 through 10","fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4781.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,5062.5,
"CTA LOWER EXTREMITY W/WO",4273706,CDM,352,RC,73706,HCPCS,OUTPATIENT,,,3760,3008,,3196,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",765.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2124.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2124.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2124.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2113.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3384,90,,,,,0,"percent of total billed charges","90% of total billed charges",1316,35,,,,,0,"percent of total billed charges","35% of total billed charges",2583.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2180.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",765.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3196,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3384,
"CTA UPPER EXTREMITY W/WO",4273206,CDM,352,RC,73206,HCPCS,OUTPATIENT,,,3650,2920,,3102.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",210.3,130,,,,,0,"fee schedule","130% of CMS OPPS rate",743.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2062.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2062.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2062.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2051.3,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",165.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3285,90,,,,,0,"percent of total billed charges","90% of total billed charges",1277.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2507.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2117,58,,,,,0,"percent of total billed charges","58% of total billed charges",743.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3102.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",161.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.59,3285,
"INJECTION FOR MYELOGRAPHY",4262284,CDM,352,RC,62284,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",174.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"ACELLULAR DERM MATRIX IMPLT",1515777,CDM,360,RC,15777,HCPCS,OUTPATIENT,,,825,660,,701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",206.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",206.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",206.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",168.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",742.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",288.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",566.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",742.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",478.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",168.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",701.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",168.05,986.63,
"AMPUTATION FOLLOW-UP SURGERY",1527884,CDM,360,RC,27884,HCPCS,OUTPATIENT,,,12500,10000,,10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",4375,35,,,,,0,"percent of total billed charges","35% of total billed charges",8587.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",7250,58,,,,,0,"percent of total billed charges","58% of total billed charges",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11250,
"AMPUTATION OF TOE",1528820,CDM,360,RC,28820,HCPCS,OUTPATIENT,,,12500,10000,,10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",4375,35,,,,,0,"percent of total billed charges","35% of total billed charges",8587.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",7250,58,,,,,0,"percent of total billed charges","58% of total billed charges",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11250,
"AMPUTATION THRU METATARSAL",1528805,CDM,360,RC,28805,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"AMPUTATION TOE & METATARSAL",1528810,CDM,360,RC,28810,HCPCS,OUTPATIENT,,,12400,9920,,10540,85,,,,,0,"percent of total billed charges","85% of total billed charges",3100,25,,,,,0,"percent of total billed charges","25% of total billed charges",3100,25,,,,,0,"percent of total billed charges","25% of total billed charges",3100,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2525.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11160,90,,,,,0,"percent of total billed charges","90% of total billed charges",4340,35,,,,,0,"percent of total billed charges","35% of total billed charges",8518.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11160,90,,,,,0,"percent of total billed charges","90% of total billed charges",7192,58,,,,,0,"percent of total billed charges","58% of total billed charges",2525.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10540,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11160,
"ANOSCOPY AND BIOPSY",1746606,CDM,360,RC,46606,HCPCS,OUTPATIENT,,,5000,4000,,4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",1750,35,,,,,0,"percent of total billed charges","35% of total billed charges",3435,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2900,58,,,,,0,"percent of total billed charges","58% of total billed charges",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4500,
"ANOSCOPY CONTROL BLEEDING",1546614,CDM,360,RC,46614,HCPCS,OUTPATIENT,,,4500,3600,,3825,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",916.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,688.15,688.15,688.15,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4050,90,,,,,0,"percent of total billed charges","90% of total billed charges",1575,35,,,,,0,"percent of total billed charges","35% of total billed charges",3091.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2610,58,,,,,0,"percent of total billed charges","58% of total billed charges",916.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3825,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4050,
APPENDECTOMY,1544950,CDM,360,RC,44950,HCPCS,OUTPATIENT,,,13390,10712,,11381.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3347.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3347.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3347.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2727.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12051,90,,,,,0,"percent of total billed charges","90% of total billed charges",4686.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9198.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12051,90,,,,,0,"percent of total billed charges","90% of total billed charges",7766.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2727.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11381.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12051,
"APPENDECTOMY ADD-ON",1544955,CDM,360,RC,44955,HCPCS,OUTPATIENT,,,12500,10000,,10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",4375,35,,,,,0,"percent of total billed charges","35% of total billed charges",8587.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",7250,58,,,,,0,"percent of total billed charges","58% of total billed charges",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11250,
"APPY; FOR RUPT APPENDIX W PERITONITIS",1544960,CDM,360,RC,44960,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,22535,
"ARTHROSC KNEE; W MEN REPAIR-MED/LAT",1529883,CDM,360,RC,29883,HCPCS,OUTPATIENT,,,22170,17736,,18844.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5542.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5542.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5542.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4516.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19953,90,,,,,0,"percent of total billed charges","90% of total billed charges",7759.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",15230.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19953,90,,,,,0,"percent of total billed charges","90% of total billed charges",12858.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4516.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18844.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19953,
"ASPIRATE/INJ GANGLION CYST",1520612,CDM,360,RC,20612,HCPCS,OUTPATIENT,,,1100,880,,935,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",224.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",385,35,,,,,0,"percent of total billed charges","35% of total billed charges",755.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",638,58,,,,,0,"percent of total billed charges","58% of total billed charges",224.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",935,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",224.07,990,
"ATT E/N/E/L;D 10.1-30SQCM",1514061,CDM,360,RC,14061,HCPCS,OUTPATIENT,,,8370,6696,,7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",7533,90,,,,,0,"percent of total billed charges","90% of total billed charges",2929.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5750.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4854.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,7533,
"ATT F/C/C/M/N/A/G/H/F; 10.1-30SQCM",1514041,CDM,360,RC,14041,HCPCS,OUTPATIENT,,,8370,6696,,7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",7533,90,,,,,0,"percent of total billed charges","90% of total billed charges",2929.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5750.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4854.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,7533,
"BIOPSY BREAST OPEN INCISIONAL",1519101,CDM,360,RC,19101,HCPCS,OUTPATIENT,,,14230,11384,,12095.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2898.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12807,90,,,,,0,"percent of total billed charges","90% of total billed charges",4980.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9776.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12807,90,,,,,0,"percent of total billed charges","90% of total billed charges",8253.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2898.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12095.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12807,
"BIOPSY BREAST W LOCALIZATION DEVICE",4019083,CDM,360,RC,19083,HCPCS,OUTPATIENT,,,4095,3276,,3480.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1023.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1023.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1023.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",834.15,20.37,,430.46,430.46,430.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,894.74,406.40,1638.13,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",3685.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1433.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2813.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3685.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2375.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",834.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1154.34,1154.34,1154.34,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3480.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",834.15,3685.5,
"BIOPSY OF ANORECTAL WALL ANAL APPROACH",1745100,CDM,360,RC,45100,HCPCS,OUTPATIENT,,,9805,7844,,8334.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1997.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",8824.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3431.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6736.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8824.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5686.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1997.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8334.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,8824.5,
"BIOPSY OF UTERUS LINING",1558100,CDM,360,RC,58100,HCPCS,OUTPATIENT,,,800,640,,680,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",237.65,130,,,,,0,"fee schedule","130% of CMS OPPS rate",162.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",186.46,102,,,,,0,"fee schedule","102% of CMS OPPS rate",720,90,,,,,0,"percent of total billed charges","90% of total billed charges",280,35,,,,,0,"percent of total billed charges","35% of total billed charges",549.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",164.52,90,,,,,0,"fee schedule","90% of CMS OPPS rate",464,58,,,,,0,"percent of total billed charges","58% of total billed charges",162.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",680,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.96,986.63,
"BIOPSY/REMOVAL LYMPH NODES",1538510,CDM,360,RC,38510,HCPCS,OUTPATIENT,,,13750,11000,,11687.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2800.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12375,90,,,,,0,"percent of total billed charges","90% of total billed charges",4812.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9446.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12375,90,,,,,0,"percent of total billed charges","90% of total billed charges",7975,58,,,,,0,"percent of total billed charges","58% of total billed charges",2800.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11687.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12375,
"BIOPSY/REMOVAL LYMPH NODES",1538530,CDM,360,RC,38530,HCPCS,OUTPATIENT,,,14225,11380,,12091.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3556.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3556.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3556.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2897.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12802.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4978.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9772.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12802.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8250.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2897.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12091.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12802.5,
"BREAST AUGMENTATION W/IMPLT",1519325,CDM,360,RC,19325,HCPCS,OUTPATIENT,,,35250,28200,,29962.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",8812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",8812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7180.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",31725,90,,,,,0,"percent of total billed charges","90% of total billed charges",12337.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",24216.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31725,90,,,,,0,"percent of total billed charges","90% of total billed charges",20445,58,,,,,0,"percent of total billed charges","58% of total billed charges",7180.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29962.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,31725,
"BREAST MAMMAPLASTY",1519318,CDM,360,RC,19318,HCPCS,OUTPATIENT,,,23820,19056,,20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",8337,35,,8296.83,8296.83,8296.83,"1 through 10","percent of total billed charges","35% of total billed charges",16364.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",13815.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,21438,
"BREAST RECONSTRUCT W OTHR",1519366,CDM,360,RC,,,OUTPATIENT,,,23820,19056,,20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",8337,35,,,,,0,"percent of total billed charges","35% of total billed charges",16364.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",13815.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,21438,
"BREAST RECONSTRUCTION",1519350,CDM,360,RC,19350,HCPCS,OUTPATIENT,,,13750,11000,,11687.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2800.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12375,90,,,,,0,"percent of total billed charges","90% of total billed charges",4812.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9446.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12375,90,,,,,0,"percent of total billed charges","90% of total billed charges",7975,58,,,,,0,"percent of total billed charges","58% of total billed charges",2800.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11687.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12375,
"BREAST SURGERY PROCEDURE",1519499,CDM,360,RC,19499,HCPCS,OUTPATIENT,,,13290,10632,,11296.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3322.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3322.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3322.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2707.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11961,90,,,,,0,"percent of total billed charges","90% of total billed charges",4651.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9130.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11961,90,,,,,0,"percent of total billed charges","90% of total billed charges",7708.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2707.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11296.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11961,
"C REP TRUNK 2.6-7.5 CM",1513101,CDM,360,RC,13101,HCPCS,OUTPATIENT,,,3415,2732,,2902.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",695.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3073.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1195.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2346.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1980.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",695.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,436.12,436.12,436.12,"1 through 10","fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2902.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,3073.5,
"C REP TRUNK EA ADTL 5CM",1513102,CDM,360,RC,13102,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,986.63,
"CANTHOTOMY SEPARATE PROCEDURE",1567715,CDM,360,RC,67715,HCPCS,OUTPATIENT,,,7955,6364,,6761.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1988.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1988.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1988.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1620.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",7159.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2784.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",5465.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7159.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4613.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1620.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6761.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,7159.5,
"CARPAL TUNNEL SURGERY",1564721,CDM,360,RC,64721,HCPCS,OUTPATIENT,,,7358.52,5886.82,,6254.74,85,,,,,0,"percent of total billed charges","85% of total billed charges",1839.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",1839.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",1839.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1498.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6622.67,90,,,,,0,"percent of total billed charges","90% of total billed charges",2575.48,35,,,,,0,"percent of total billed charges","35% of total billed charges",5055.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6622.67,90,,,,,0,"percent of total billed charges","90% of total billed charges",4267.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",1498.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6254.74,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6622.67,
"CHEMODENERVATION ANAL MUSC",1546505,CDM,360,RC,46505,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,840.04,840.04,840.04,"1 through 10","fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,5400,
"CMPLX RPR F/C/C/M/M/N/AX/G/H/F",1513132,CDM,360,RC,13132,HCPCS,OUTPATIENT,,,2400,1920,,2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2160,90,,,,,0,"percent of total billed charges","90% of total billed charges",840,35,,448.00,203.91,692.08,"1 through 10","percent of total billed charges","35% of total billed charges",1648.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1392,58,,,,,0,"percent of total billed charges","58% of total billed charges",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,436.12,436.12,436.12,"1 through 10","fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",488.88,2160,
"CMPLX RPR S/A/L ADDL 5 CM/>",1513122,CDM,360,RC,13122,HCPCS,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,986.63,
"CMPLX RR S/A/L 2.6-7.5CM",1513121,CDM,360,RC,13121,HCPCS,OUTPATIENT,,,2325,1860,,1976.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",473.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2092.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",813.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1597.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1348.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",473.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1976.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",473.6,2092.5,
"COLECTOMY PARTIAL W/END COLOSTOMY CLSR",1544143,CDM,360,RC,44143,HCPCS,OUTPATIENT,,,9660,7728,,8211,85,,,,,0,"percent of total billed charges","85% of total billed charges",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1967.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8694,90,,,,,0,"percent of total billed charges","90% of total billed charges",3381,35,,,,,0,"percent of total billed charges","35% of total billed charges",6636.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5602.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1967.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8211,85,,,,,0,"percent of total billed charges","85% of total billed charges",9660,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,9660,
"COLONOSCOPY STOMA W/BIOPSY",1544389,CDM,360,RC,44389,HCPCS,OUTPATIENT,,,6120,4896,,5202,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1246.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5508,90,,,,,0,"percent of total billed charges","90% of total billed charges",2142,35,,,,,0,"percent of total billed charges","35% of total billed charges",4204.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3549.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1246.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5202,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,5508,
"COLONOSCOPY W/FB REMOVAL",1545379,CDM,360,RC,45379,HCPCS,OUTPATIENT,,,6120,4896,,5202,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1246.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5508,90,,,,,0,"percent of total billed charges","90% of total billed charges",2142,35,,,,,0,"percent of total billed charges","35% of total billed charges",4204.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3549.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1246.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5202,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,5508,
"COLONOSCOPY W/RESECTION",1545390,CDM,360,RC,45390,HCPCS,OUTPATIENT,,,11015,8812,,9362.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2753.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2753.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2753.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2243.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9913.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3855.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7567.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9913.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6388.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",2243.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9362.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9913.5,
"CORRECTION HALLUX VALGUS",1528292,CDM,360,RC,28292,HCPCS,OUTPATIENT,,,17065,13652,,14505.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3476.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,2527.01,2527.01,2527.01,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",15358.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5972.75,35,,2724.48,2724.48,2724.48,"1 through 10","percent of total billed charges","35% of total billed charges",11723.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",15358.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9897.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3476.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,2311.62,2311.62,2311.62,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14505.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,15358.5,
"CORRJ HALUX RIGDUS W/O IMPCT",1528289,CDM,360,RC,28289,HCPCS,OUTPATIENT,,,11495,9196,,9770.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2873.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2873.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2873.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2341.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10345.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4023.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7897.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10345.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6667.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2341.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9770.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10345.5,
"DBRDMT BONE 1ST 20 SQ CM/<",1511044,CDM,360,RC,11044,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"DEB SUBQ TISSUE 20 SQ CM/<",1511042,CDM,360,RC,11042,HCPCS,OUTPATIENT,,,1545,1236,,1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,170.21,170.21,170.21,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1390.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",540.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1061.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",896.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,284.65,284.65,284.65,"1 through 10","fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",314.72,1390.5,
"DEB SUBQ TISSUE ADDON ADDL 20 SQ CM",1511045,CDM,360,RC,11045,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,986.63,
"DEBRIDE INFECTED SKIN",1511000,CDM,360,RC,11000,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,2250,
"DEBRIDEMENT MUSCLE EA ADDL 20 SQ CM",1511046,CDM,360,RC,11046,HCPCS,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,986.63,
"DEBRIDEMENT MUSCLE/FASCIA 20 SQ CM/<",1511043,CDM,360,RC,11043,HCPCS,OUTPATIENT,,,2060,1648,,1751,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",419.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1854,90,,,,,0,"percent of total billed charges","90% of total billed charges",721,35,,,,,0,"percent of total billed charges","35% of total billed charges",1415.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1194.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",419.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1751,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",419.62,1854,
"DECOMPRESS PLANTAR DIGITAL NERVE",1564726,CDM,360,RC,64726,HCPCS,OUTPATIENT,,,7440,5952,,6324,85,,,,,0,"percent of total billed charges","85% of total billed charges",1860,25,,,,,0,"percent of total billed charges","25% of total billed charges",1860,25,,,,,0,"percent of total billed charges","25% of total billed charges",1860,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1515.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6696,90,,,,,0,"percent of total billed charges","90% of total billed charges",2604,35,,,,,0,"percent of total billed charges","35% of total billed charges",5111.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6696,90,,,,,0,"percent of total billed charges","90% of total billed charges",4315.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1515.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6324,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6696,
"DELAY FLAP F/C/C/N/AX/G/H/G",1515620,CDM,360,RC,15620,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,651.62,651.62,651.62,"1 through 10","fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6750,
"DESTROY ANAL LESION SIMPLE",1746922,CDM,360,RC,46922,HCPCS,OUTPATIENT,,,9805,7844,,8334.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2451.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1997.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",8824.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3431.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6736.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8824.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5686.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1997.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8334.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,8824.5,
"DESTRUCT B9 LESION 1-14",1517110,CDM,360,RC,17110,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.91,986.63,
"DESTRUCTION OF ANAL LESION(S)",1746910,CDM,360,RC,46910,HCPCS,OUTPATIENT,,,9530,7624,,8100.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1941.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",8577,90,,,,,0,"percent of total billed charges","90% of total billed charges",3335.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6547.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",5527.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1941.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8100.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,8577,
"DIAGNOSTIC ANOSCOPY SPX",1546600,CDM,360,RC,46600,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,12.41,12.41,12.41,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,2250,
"DIAGNOSTIC SIGMOIDOSCOPY",1545330,CDM,360,RC,45330,HCPCS,OUTPATIENT,,,3605,2884,,3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,5.30,5.30,5.30,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3244.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1261.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2476.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2090.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,690.15,690.15,690.15,"1 through 10","fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",734.34,3244.5,
"DRAIN/INJ JOINT/BURSA W/O US",1520610,CDM,360,RC,20610,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,210.31,210.31,210.31,"1 through 10","fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,1080,
"DRAIN/INJ JOINT/BURSA W/US",1520611,CDM,360,RC,20611,HCPCS,OUTPATIENT,,,1500,1200,,1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",525,35,,,,,0,"percent of total billed charges","35% of total billed charges",1030.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",870,58,,,,,0,"percent of total billed charges","58% of total billed charges",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,1350,
"DRAINAGE ABDOM ABSCESS OPEN",1549020,CDM,360,RC,49020,HCPCS,OUTPATIENT,,,12500,10000,,10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",4375,35,,,,,0,"percent of total billed charges","35% of total billed charges",8587.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",7250,58,,,,,0,"percent of total billed charges","58% of total billed charges",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",12500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,12500,
"DRAINAGE OF HEMATOMA/FLUID",1510140,CDM,360,RC,10140,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5625,
"DRAINAGE OF PELVIS LESION",1526990,CDM,360,RC,26990,HCPCS,OUTPATIENT,,,13000,10400,,11050,85,,,,,0,"percent of total billed charges","85% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2648.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11700,90,,,,,0,"percent of total billed charges","90% of total billed charges",4550,35,,,,,0,"percent of total billed charges","35% of total billed charges",8931,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11700,90,,,,,0,"percent of total billed charges","90% of total billed charges",7540,58,,,,,0,"percent of total billed charges","58% of total billed charges",2648.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,2311.62,2311.62,2311.62,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11050,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11700,
"DRAINAGE OF SKIN ABSCESS",1610060,CDM,360,RC,10060,HCPCS,OUTPATIENT,,,1750,1400,,1487.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",356.48,20.37,,117.28,117.28,117.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,749.81,121.30,1642.50,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1575,90,,,,,0,"percent of total billed charges","90% of total billed charges",612.5,35,,114.95,114.95,114.95,"1 through 10","percent of total billed charges","35% of total billed charges",1202.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1015,58,,,,,0,"percent of total billed charges","58% of total billed charges",356.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,141.57,141.57,141.57,"1 through 10","fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1487.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,1575,
"DRAINAGE OF SKIN ABSECESS",1710060,CDM,360,RC,10060,HCPCS,OUTPATIENT,,,1500,1200,,1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",305.55,20.37,,117.28,117.28,117.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,749.81,121.30,1642.50,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",525,35,,114.95,114.95,114.95,"1 through 10","percent of total billed charges","35% of total billed charges",1030.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",870,58,,,,,0,"percent of total billed charges","58% of total billed charges",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,141.57,141.57,141.57,"1 through 10","fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,1350,
"EGD BALLOON DIL ESOPH 30 MM/>",1543233,CDM,360,RC,43233,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6750,
"EGD CONTROL BLEEDING ANY METHOD",1543255,CDM,360,RC,43255,HCPCS,OUTPATIENT,,,7750,6200,,6587.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1937.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1937.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1937.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1578.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,129.49,129.49,129.49,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6975,90,,,,,0,"percent of total billed charges","90% of total billed charges",2712.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5324.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6975,90,,,,,0,"percent of total billed charges","90% of total billed charges",4495,58,,,,,0,"percent of total billed charges","58% of total billed charges",1578.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6587.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6975,
"EGD DIAGNOSTIC BRUSH WASH",1543235,CDM,360,RC,43235,HCPCS,OUTPATIENT,,,3605,2884,,3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,794.31,260.86,1604.00,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3244.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1261.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2476.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2090.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,667.96,667.96,667.96,"1 through 10","fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",734.34,3244.5,
"EGD PLACE GASTROSTOMY TUBE",1543246,CDM,360,RC,43246,HCPCS,OUTPATIENT,,,8370,6696,,7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2092.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",7533,90,,,,,0,"percent of total billed charges","90% of total billed charges",2929.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5750.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7533,90,,,,,0,"percent of total billed charges","90% of total billed charges",4854.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1704.97,20.37,,37.49,37.49,37.49,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,1351.52,1351.52,1351.52,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,7533,
"ENDOMETR ABLATE THERMAL",1558353,CDM,360,RC,58353,HCPCS,OUTPATIENT,,,19000,15200,,16150,85,,,,,0,"percent of total billed charges","85% of total billed charges",4750,25,,,,,0,"percent of total billed charges","25% of total billed charges",4750,25,,,,,0,"percent of total billed charges","25% of total billed charges",4750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3870.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",17100,90,,,,,0,"percent of total billed charges","90% of total billed charges",6650,35,,,,,0,"percent of total billed charges","35% of total billed charges",13053,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",17100,90,,,,,0,"percent of total billed charges","90% of total billed charges",11020,58,,,,,0,"percent of total billed charges","58% of total billed charges",3870.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",16150,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,17100,
"EX ARM/ELBOW TUM DEEP 5 CM/>",1524073,CDM,360,RC,24073,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC ABD LES SC < 3CM",1522902,CDM,360,RC,22902,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC ABD LES SC 3 CM >",1522903,CDM,360,RC,22903,HCPCS,OUTPATIENT,,,10045,8036,,8538.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2511.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2511.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2511.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2046.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9040.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3515.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6900.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9040.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5826.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2046.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8538.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9040.5,
"EXC ABDL TUM DDEP < 5CM",1522900,CDM,360,RC,22900,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC ABDL TUM DDEP 5CM/>",1522901,CDM,360,RC,22901,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC ARM/ELBOW LES SC 3 CM/>",1524071,CDM,360,RC,24071,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1204.82,1204.82,1204.82,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC B9 LESION MR GN",1511440,CDM,360,RC,11440,HCPCS,OUTPATIENT,,,2605,2084,,2214.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",530.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2344.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",911.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1789.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1510.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",530.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2214.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",530.64,2344.5,
"EXC BACK LES SC < 3CM",1521930,CDM,360,RC,21930,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1154.34,1154.34,1154.34,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC BACK LES SC 3 CM/>",1521931,CDM,360,RC,21931,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1154.34,1154.34,1154.34,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC BACK TUM DEEP <5 CM",1521932,CDM,360,RC,21932,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC BACK TUM DEEP 5 CM/>",1521933,CDM,360,RC,21933,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC BREASTLES BY N LOC; SGL",1519125,CDM,360,RC,19125,HCPCS,OUTPATIENT,,,11305,9044,,9609.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2826.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2826.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2826.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2302.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10174.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3956.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7766.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10174.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6556.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2302.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9609.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10174.5,
"EXC F/E/E/N/L MAL+MRG 0.6-1",1511641,CDM,360,RC,11641,HCPCS,OUTPATIENT,,,3500,2800,,2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",1225,35,,,,,0,"percent of total billed charges","35% of total billed charges",2404.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2030,58,,,,,0,"percent of total billed charges","58% of total billed charges",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,250.63,250.63,250.63,"1 through 10","fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,3150,
"EXC FACE LES SBQ 2 CM/>",1521012,CDM,360,RC,21012,HCPCS,OUTPATIENT,,,6500,5200,,5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",2275,35,,,,,0,"percent of total billed charges","35% of total billed charges",4465.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",3770,58,,,,,0,"percent of total billed charges","58% of total billed charges",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5850,
"EXC FACE TUM DEEP 2 CM/>",1521014,CDM,360,RC,21014,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1399.93,724.01,2075.84,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"EXC FACE-MM B9 + MARG > 4 CM",1511446,CDM,360,RC,11446,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC FACE-MM B9+MARG 0.6-1 CM",1511441,CDM,360,RC,11441,HCPCS,OUTPATIENT,,,3500,2800,,2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",1225,35,,,,,0,"percent of total billed charges","35% of total billed charges",2404.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2030,58,,,,,0,"percent of total billed charges","58% of total billed charges",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,501.27,501.27,501.27,"1 through 10","fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,3150,
"EXC FACE-MM B9+MARG 1.1-2 CM",1511442,CDM,360,RC,11442,HCPCS,OUTPATIENT,,,2750,2200,,2337.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",560.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2475,90,,,,,0,"percent of total billed charges","90% of total billed charges",962.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1889.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1595,58,,,,,0,"percent of total billed charges","58% of total billed charges",560.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2337.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",560.18,2475,
"EXC FACE-MM B9+MARG 2.1-3CM",1511443,CDM,360,RC,11443,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5625,
"EXC FOOT/TOE TUM DEP 1.5CM/>",1528041,CDM,360,RC,28041,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC FOOT/TOE TUM SC < 1.5 CM",1528043,CDM,360,RC,28043,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC FOREARM LES SC 3 CM/>",1525071,CDM,360,RC,25071,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5625,
"EXC FOREARM TUM DEEP 3 CM/>",1525073,CDM,360,RC,25073,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"EXC HAND TUM DEEP 1.5 CM/>",1526113,CDM,360,RC,26113,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5625,
"EXC H-F-NK-SP B9+MARG 1.1-2",1511422,CDM,360,RC,11422,HCPCS,OUTPATIENT,,,6500,5200,,5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,20.37,,114.17,114.17,114.17,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",2275,35,,,,,0,"percent of total billed charges","35% of total billed charges",4465.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",3770,58,,,,,0,"percent of total billed charges","58% of total billed charges",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5850,
"EXC H-F-NK-SP B9+MARG 2.1-3",1511423,CDM,360,RC,11423,HCPCS,OUTPATIENT,,,6500,5200,,5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",2275,35,,,,,0,"percent of total billed charges","35% of total billed charges",4465.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",3770,58,,,,,0,"percent of total billed charges","58% of total billed charges",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1154.34,1154.34,1154.34,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5850,
"EXC H-F-NK-SP B9+MARG 3.1-4",1511424,CDM,360,RC,11424,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC H-F-NK-SP B9+MARG>4CM",1511426,CDM,360,RC,11426,HCPCS,OUTPATIENT,,,10500,8400,,8925,85,,,,,0,"percent of total billed charges","85% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2138.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9450,90,,,,,0,"percent of total billed charges","90% of total billed charges",3675,35,,,,,0,"percent of total billed charges","35% of total billed charges",7213.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9450,90,,,,,0,"percent of total billed charges","90% of total billed charges",6090,58,,,,,0,"percent of total billed charges","58% of total billed charges",2138.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8925,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9450,
"EXC HIP PELVIS LES SC 3 CM/>",1527043,CDM,360,RC,27043,HCPCS,OUTPATIENT,,,10500,8400,,8925,85,,,,,0,"percent of total billed charges","85% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2138.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9450,90,,,,,0,"percent of total billed charges","90% of total billed charges",3675,35,,,,,0,"percent of total billed charges","35% of total billed charges",7213.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9450,90,,,,,0,"percent of total billed charges","90% of total billed charges",6090,58,,,,,0,"percent of total billed charges","58% of total billed charges",2138.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8925,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9450,
"EXC HIP/PELVIS LES SC< 3 CM",1527047,CDM,360,RC,27047,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC LEG/ANKLE TUM < 3 CM",1527618,CDM,360,RC,27618,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,153.57,153.57,153.57,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6750,
"EXC LEG/ANKLE TUM DEP 5 CM/>",1527634,CDM,360,RC,27634,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"EXC NECK LES SC < 3 CM",1521555,CDM,360,RC,21555,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1373.49,537.54,2209.43,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,78.93,78.93,78.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC NECK LES SC 3 CM/>",1521552,CDM,360,RC,21552,HCPCS,OUTPATIENT,,,10625,8500,,9031.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2656.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2656.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2656.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2164.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,499.38,482.74,516.01,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9562.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3718.75,35,,334.81,334.81,334.81,"1 through 10","percent of total billed charges","35% of total billed charges",7299.38,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9562.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6162.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2164.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,2039.08,2039.08,2039.08,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9031.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9562.5,
"EXC NECK TUM DEEP < 5 CM",1521556,CDM,360,RC,21556,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC NECK TUM DEEP 5 CM/>",1521554,CDM,360,RC,21554,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1779.17,1779.17,1779.17,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC PAROTID GLAND/LESION",1542415,CDM,360,RC,42415,HCPCS,OUTPATIENT,,,21375,17100,,18168.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4354.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19237.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7481.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",14684.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19237.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12397.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",4354.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18168.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19237.5,
"EXC RECT TUM TRANSANAL PART",1545171,CDM,360,RC,45171,HCPCS,OUTPATIENT,,,10275,8220,,8733.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2093.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3596.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7058.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5959.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2093.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1953.83,1953.83,1953.83,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8733.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9247.5,
"EXC S/N/H/F/G MAL+MRG>4CM",1511626,CDM,360,RC,11626,HCPCS,OUTPATIENT,,,10500,8400,,8925,85,,,,,0,"percent of total billed charges","85% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",2625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2138.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9450,90,,,,,0,"percent of total billed charges","90% of total billed charges",3675,35,,,,,0,"percent of total billed charges","35% of total billed charges",7213.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9450,90,,,,,0,"percent of total billed charges","90% of total billed charges",6090,58,,,,,0,"percent of total billed charges","58% of total billed charges",2138.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8925,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9450,
"EXC SHOULDER LES SC 3 CM/>",1523071,CDM,360,RC,23071,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6750,
"EXC SHOULDER TUM DDEP < 5 CM",1523076,CDM,360,RC,23076,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC SHOULDER TUM DDEP 5 CM/>",1523073,CDM,360,RC,23073,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC SKN H/P/P/P/U SMPL/NTRM",1511470,CDM,360,RC,11470,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC SKN HDRDNT AX SMPL/NTRM",1511450,CDM,360,RC,11450,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"EXC SKN HDRDNT ING COMPLEX",1511463,CDM,360,RC,11463,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,3806.62,3806.62,3806.62,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"EXC THIGH/KNEE LES SC < 3 CM",1527327,CDM,360,RC,27327,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5625,
"EXC THIGH/KNEE LES SC 3 CM/>",1527337,CDM,360,RC,27337,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"EXC THIGH/KNEE TUM DEEP < 5CM",1527328,CDM,360,RC,27328,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,2039.08,2039.08,2039.08,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"EXC TR-EXT B9+MARG 0.6-1 CM",1511401,CDM,360,RC,11401,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
"EXC TR-EXT B9+MARG 3.1-4 CM",1511404,CDM,360,RC,11404,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC TR-EXT B9+MARG>4.0CM",1511406,CDM,360,RC,11406,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1774.74,1774.74,1774.74,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"EXC TR-EXT MAL+MARG 1.1-2CM",1511602,CDM,360,RC,11602,HCPCS,OUTPATIENT,,,1500,1200,,1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",525,35,,,,,0,"percent of total billed charges","35% of total billed charges",1030.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",870,58,,,,,0,"percent of total billed charges","58% of total billed charges",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",305.55,1350,
"EXC TR-EXT MAL+MARG 3.1-4CM",1511604,CDM,360,RC,11604,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",509.25,2250,
"EXC/CRTG B1 CST/B9 TUM RDS",1524120,CDM,360,RC,24120,HCPCS,OUTPATIENT,,,12500,10000,,10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",4375,35,,,,,0,"percent of total billed charges","35% of total billed charges",8587.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",7250,58,,,,,0,"percent of total billed charges","58% of total billed charges",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11250,
"EXCISE HYDROCELE; BILATERAL",1555041,CDM,360,RC,55041,HCPCS,OUTPATIENT,,,11590,9272,,9851.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2897.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2897.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2897.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2360.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10431,90,,,,,0,"percent of total billed charges","90% of total billed charges",4056.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7962.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10431,90,,,,,0,"percent of total billed charges","90% of total billed charges",6722.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2360.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9851.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10431,
"EXCISE PAROTID GLAND LESION",1542410,CDM,360,RC,42410,HCPCS,OUTPATIENT,,,21400,17120,,18190,85,,,,,0,"percent of total billed charges","85% of total billed charges",5350,25,,,,,0,"percent of total billed charges","25% of total billed charges",5350,25,,,,,0,"percent of total billed charges","25% of total billed charges",5350,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4359.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19260,90,,,,,0,"percent of total billed charges","90% of total billed charges",7490,35,,,,,0,"percent of total billed charges","35% of total billed charges",14701.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19260,90,,,,,0,"percent of total billed charges","90% of total billed charges",12412,58,,,,,0,"percent of total billed charges","58% of total billed charges",4359.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18190,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19260,
"EXCISION ANUS SKIN TAG",1746230,CDM,360,RC,,,OUTPATIENT,,,1795,1436,,1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",628.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1233.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1041.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,1615.5,
"EXCISION BEN LESION 2.1-3.0CM",1711403,CDM,360,RC,11403,HCPCS,OUTPATIENT,,,3840,3072,,3264,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",782.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3456,90,,,,,0,"percent of total billed charges","90% of total billed charges",1344,35,,,,,0,"percent of total billed charges","35% of total billed charges",2638.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2227.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",782.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3264,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,3456,
"EXCISION BENIGN LESION INCL MARGINS",1511402,CDM,360,RC,11402,HCPCS,OUTPATIENT,,,2320,1856,,1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,334.69,248.23,421.14,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2088,90,,,,,0,"percent of total billed charges","90% of total billed charges",812,35,,,,,0,"percent of total billed charges","35% of total billed charges",1593.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1345.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",472.58,2088,
"EXCISION HIDRADENITIS INGUINAL SMPL/INTR",1511462,CDM,360,RC,11462,HCPCS,OUTPATIENT,,,10625,8500,,9031.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2656.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2656.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2656.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2164.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9562.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3718.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7299.38,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9562.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6162.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2164.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9031.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9562.5,
"EXCISION MALIGNANT LESION",1511606,CDM,360,RC,11606,HCPCS,OUTPATIENT,,,5925,4740,,5036.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1481.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1481.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1481.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1206.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5332.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2073.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4070.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5332.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3436.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1206.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5036.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5332.5,
"EXCISION OF SUBMANDIBULARGLAND",1542440,CDM,360,RC,42440,HCPCS,OUTPATIENT,,,23820,19056,,20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",8337,35,,,,,0,"percent of total billed charges","35% of total billed charges",16364.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",13815.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,21438,
"EXCISION OLECRANON BURSA",1524105,CDM,360,RC,24105,HCPCS,OUTPATIENT,,,12000,9600,,10200,85,,,,,0,"percent of total billed charges","85% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2444.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10800,90,,,,,0,"percent of total billed charges","90% of total billed charges",4200,35,,,,,0,"percent of total billed charges","35% of total billed charges",8244,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10800,90,,,,,0,"percent of total billed charges","90% of total billed charges",6960,58,,,,,0,"percent of total billed charges","58% of total billed charges",2444.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10200,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10800,
"EXCISION TUMOR  UPPER ARM < 3 CM",1724075,CDM,360,RC,24075,HCPCS,OUTPATIENT,,,5115,4092,,4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1790.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3514.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2966.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,4603.5,
"EXPLORE PARATHYROID GLANDS",1560500,CDM,360,RC,60500,HCPCS,OUTPATIENT,,,21375,17100,,18168.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4354.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19237.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7481.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",14684.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19237.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12397.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",4354.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18168.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19237.5,
"FREEING OF BOWEL ADHESION",1544005,CDM,360,RC,44005,HCPCS,OUTPATIENT,,,12875,10300,,10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",11587.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4506.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8845.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",7467.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,12875,
"FTH GR FR F/C/C/M/N/AX/G/H/F",1515240,CDM,360,RC,15240,HCPCS,OUTPATIENT,,,7000,5600,,5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6300,90,,,,,0,"percent of total billed charges","90% of total billed charges",2450,35,,,,,0,"percent of total billed charges","35% of total billed charges",4809,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4060,58,,,,,0,"percent of total billed charges","58% of total billed charges",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6300,
"GRFG AUTO L FAT LIPO 50 CC/<",1515771,CDM,360,RC,15771,HCPCS,OUTPATIENT,,,14820,11856,,12597,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4324.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",3018.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,793.05,793.05,793.05,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3393.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",13338,90,,,,,0,"percent of total billed charges","90% of total billed charges",5187,35,,,,,0,"percent of total billed charges","35% of total billed charges",10181.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2994.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8595.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",3018.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12597,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,13338,
"GRFG AUTO L FAT LIPO EA ADDL",1515772,CDM,360,RC,15772,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,986.63,
"HAMMERTOE OP ONE TOE",1528285,CDM,360,RC,28285,HCPCS,OUTPATIENT,,,13200,10560,,11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",4620,35,,,,,0,"percent of total billed charges","35% of total billed charges",9068.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",7656,58,,,,,0,"percent of total billed charges","58% of total billed charges",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11880,
HEMORRHOIDECTOMY,1746083,CDM,360,RC,,,OUTPATIENT,,,1795,1436,,1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",448.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",628.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1233.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1041.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",365.64,1615.5,
"HEMORRHOIDECTOMY INT XTRNL",1546260,CDM,360,RC,46260,HCPCS,OUTPATIENT,,,9530,7624,,8100.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2382.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1941.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",8577,90,,,,,0,"percent of total billed charges","90% of total billed charges",3335.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6547.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8577,90,,,,,0,"percent of total billed charges","90% of total billed charges",5527.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1941.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8100.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,8577,
"HEMORRHOIDOPEXY BY STAPLING",1546947,CDM,360,RC,46947,HCPCS,OUTPATIENT,,,10580,8464,,8993,85,,,,,0,"percent of total billed charges","85% of total billed charges",2645,25,,,,,0,"percent of total billed charges","25% of total billed charges",2645,25,,,,,0,"percent of total billed charges","25% of total billed charges",2645,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2155.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9522,90,,,,,0,"percent of total billed charges","90% of total billed charges",3703,35,,,,,0,"percent of total billed charges","35% of total billed charges",7268.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9522,90,,,,,0,"percent of total billed charges","90% of total billed charges",6136.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2155.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8993,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9522,
"HERNIA REPAIR W/MESH",1549568,CDM,360,RC,,,OUTPATIENT,,,1355,1084,,1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",474.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",930.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",785.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,1219.5,
"I & D PERIANAL ABSCESS",1546050,CDM,360,RC,46050,HCPCS,OUTPATIENT,,,3865,3092,,3285.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",787.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,418.90,418.90,418.90,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3478.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1352.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2655.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2241.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",787.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3285.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,3478.5,
"I & D SIMPLE ABCESS",2110060,CDM,360,RC,10060,HCPCS,OUTPATIENT,,,720,576,,612,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",146.66,20.37,,117.28,117.28,117.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,749.81,121.30,1642.50,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",648,90,,,,,0,"percent of total billed charges","90% of total billed charges",252,35,,114.95,114.95,114.95,"1 through 10","percent of total billed charges","35% of total billed charges",494.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",417.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",146.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,141.57,141.57,141.57,"1 through 10","fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",612,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",146.66,986.63,
"I&D ABSC; COMPL OR MULTI",1510061,CDM,360,RC,10061,HCPCS,OUTPATIENT,,,1545,1236,,1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,205.10,99.11,801.90,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1390.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",540.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1061.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",896.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,284.65,284.65,284.65,"1 through 10","fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",314.72,1390.5,
"INCAL BX SKIN SINGLE LES",1511106,CDM,360,RC,11106,HCPCS,OUTPATIENT,,,2575,2060,,2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2317.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",901.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1769.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1493.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,2317.5,
"INCISE EXTERNAL HEMORRHOID",1546083,CDM,360,RC,46083,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",193.52,986.63,
"INCISE FOOT/TOE FASCIA",1528008,CDM,360,RC,28008,HCPCS,OUTPATIENT,,,17065,13652,,14505.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3476.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",15358.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5972.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",11723.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",15358.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9897.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3476.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14505.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,15358.5,
"INCISION OF RECTAL ABSCESS",1546040,CDM,360,RC,46040,HCPCS,OUTPATIENT,,,5000,4000,,4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,471.55,471.55,471.55,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",1750,35,,,,,0,"percent of total billed charges","35% of total billed charges",3435,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2900,58,,,,,0,"percent of total billed charges","58% of total billed charges",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4500,
"INCISION OF RECTAL ABSCESS",1546045,CDM,360,RC,46045,HCPCS,OUTPATIENT,,,10275,8220,,8733.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2093.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3596.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7058.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5959.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2093.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8733.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9247.5,
"INCISION OF RECTAL ABSCESS",1546060,CDM,360,RC,46060,HCPCS,OUTPATIENT,,,10800,8640,,9180,85,,,,,0,"percent of total billed charges","85% of total billed charges",2700,25,,,,,0,"percent of total billed charges","25% of total billed charges",2700,25,,,,,0,"percent of total billed charges","25% of total billed charges",2700,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2199.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,2094.30,2094.30,2094.30,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9720,90,,,,,0,"percent of total billed charges","90% of total billed charges",3780,35,,,,,0,"percent of total billed charges","35% of total billed charges",7419.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9720,90,,,,,0,"percent of total billed charges","90% of total billed charges",6264,58,,,,,0,"percent of total billed charges","58% of total billed charges",2199.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9180,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9720,
"INCISION OF SPINAL NERVE",1564772,CDM,360,RC,64772,HCPCS,OUTPATIENT,,,7725,6180,,6566.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1931.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1931.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1931.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1573.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6952.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2703.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",5307.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6952.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4480.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1573.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6566.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6952.5,
"INJ SCLEROSING SOLUTION HEMORRHOIDS",2046500,CDM,360,RC,46500,HCPCS,OUTPATIENT,,,2215,1772,,1882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",451.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",775.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1521.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1284.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",451.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",451.2,1993.5,
"INJECT SKIN LESIONS </W7",1511900,CDM,360,RC,11900,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,986.63,
"INJECTION AA/STRD BRACH PLEXUS",1564415,CDM,360,RC,64415,HCPCS,OUTPATIENT,,,3505,2804,,2979.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1051.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",713.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",825.21,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3154.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1226.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2407.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",728.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2032.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",713.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2979.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",713.97,3154.5,
"INJECTION FOR BREAST X-RAY",1519030,CDM,360,RC,19030,HCPCS,OUTPATIENT,,,600,480,,510,85,,,,,0,"percent of total billed charges","85% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",210,35,,,,,0,"percent of total billed charges","35% of total billed charges",412.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",348,58,,,,,0,"percent of total billed charges","58% of total billed charges",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",510,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",122.22,986.63,
"INS TUNNELED CVAD W PORT 5YRS/>",1536561,CDM,360,RC,,,OUTPATIENT,,,13200,10560,,11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",4620,35,,,,,0,"percent of total billed charges","35% of total billed charges",9068.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",7656,58,,,,,0,"percent of total billed charges","58% of total billed charges",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,11880,
"INSERT EMERGENCY AIRWAY",1531500,CDM,360,RC,31500,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1545.78,1337.27,1754.29,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,168.44,168.44,168.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",211.02,100,,165.44,165.44,165.44,"1 through 10","fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,986.63,
"INSERT NON-TUNNEL CV CATH",1536556,CDM,360,RC,36556,HCPCS,OUTPATIENT,,,12000,9600,,10200,85,,,,,0,"percent of total billed charges","85% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",3000,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2444.4,20.37,,78.83,78.83,78.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10800,90,,,,,0,"percent of total billed charges","90% of total billed charges",4200,35,,,,,0,"percent of total billed charges","35% of total billed charges",8244,68.7,,5294.72,5294.72,5294.72,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10800,90,,,,,0,"percent of total billed charges","90% of total billed charges",6960,58,,,,,0,"percent of total billed charges","58% of total billed charges",2444.4,20.37,,324.09,324.09,324.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,2242.45,2242.45,2242.45,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10200,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10800,
"INSERT TUNNELED CV CATH",1536560,CDM,360,RC,36560,HCPCS,OUTPATIENT,,,13200,10560,,11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",4620,35,,,,,0,"percent of total billed charges","35% of total billed charges",9068.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",7656,58,,,,,0,"percent of total billed charges","58% of total billed charges",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11880,
"INSERTION DRUG DLVR IMPLANT",1511981,CDM,360,RC,11981,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,986.63,
"INSERTION OF CHEST TUBE",1532551,CDM,360,RC,32551,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1348.27,1348.27,1348.27,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1106.75,1106.75,1106.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"INSJ BREAST IMPLT SM D MAST",1519340,CDM,360,RC,19340,HCPCS,OUTPATIENT,,,24980,19984,,21233,85,,,,,0,"percent of total billed charges","85% of total billed charges",6245,25,,,,,0,"percent of total billed charges","25% of total billed charges",6245,25,,,,,0,"percent of total billed charges","25% of total billed charges",6245,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5088.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",22482,90,,,,,0,"percent of total billed charges","90% of total billed charges",8743,35,,,,,0,"percent of total billed charges","35% of total billed charges",17161.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22482,90,,,,,0,"percent of total billed charges","90% of total billed charges",14488.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",5088.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21233,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,22482,
"INSJ PICC RS&I 5YR+",1536573,CDM,360,RC,36573,HCPCS,OUTPATIENT,,,4510,3608,,3833.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1127.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1127.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1127.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",918.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",4059,90,,,,,0,"percent of total billed charges","90% of total billed charges",1578.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3098.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4059,90,,,,,0,"percent of total billed charges","90% of total billed charges",2615.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",918.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3833.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,4059,
"INSJ/RPLCMT BRST IMPLT SEPD",1519342,CDM,360,RC,19342,HCPCS,OUTPATIENT,,,37520,30016,,31892,85,,,,,0,"percent of total billed charges","85% of total billed charges",9380,25,,,,,0,"percent of total billed charges","25% of total billed charges",9380,25,,,,,0,"percent of total billed charges","25% of total billed charges",9380,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7642.82,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,8542.84,4980.87,13770.00,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",33768,90,,,,,0,"percent of total billed charges","90% of total billed charges",13132,35,,,,,0,"percent of total billed charges","35% of total billed charges",25776.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",33768,90,,,,,0,"percent of total billed charges","90% of total billed charges",21761.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",7642.82,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,6879.38,6879.38,6879.38,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31892,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,33768,
"INT HRHC LIG 1 HROID W/O IMG",1546945,CDM,360,RC,46945,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"INT HRHC LIG 2 HROID W/O IMG",1546946,CDM,360,RC,46946,HCPCS,OUTPATIENT,,,11035,8828,,9379.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2758.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2758.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2758.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2247.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9931.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3862.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7581.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9931.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6400.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2247.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9379.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9931.5,
"INTDMD RPR S/A/A/T/EXT 12.6-20",1512035,CDM,360,RC,12035,HCPCS,OUTPATIENT,,,2000,1600,,1700,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",407.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1800,90,,,,,0,"percent of total billed charges","90% of total billed charges",700,35,,,,,0,"percent of total billed charges","35% of total billed charges",1374,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1160,58,,,,,0,"percent of total billed charges","58% of total billed charges",407.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1700,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,1800,
"INTMD RPR S/TR/EXT 7.6 12.5",1512034,CDM,360,RC,12034,HCPCS,OUTPATIENT,,,1395,1116,,1185.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",284.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1255.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",488.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",958.37,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",809.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",284.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1185.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",284.16,1255.5,
"IO MAP OF SENT LYMPH NODE",1538900,CDM,360,RC,38900,HCPCS,OUTPATIENT,,,1545,1236,,1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",386.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",386.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",1390.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",540.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1061.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1390.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",896.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",314.72,1390.5,
"KNEE ARTHROSCOPY SURGERY",1529881,CDM,360,RC,29881,HCPCS,OUTPATIENT,,,21245,16996,,18058.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5311.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5311.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5311.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4327.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19120.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7435.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",14595.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19120.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12322.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",4327.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18058.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19120.5,
"KNEE ARTHROSCOPY/SURGERY",1529875,CDM,360,RC,29875,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"KNEE ARTHROSCOPY/SURGERY",1529880,CDM,360,RC,29880,HCPCS,OUTPATIENT,,,21245,16996,,18058.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5311.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5311.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5311.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4327.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19120.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7435.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",14595.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19120.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12322.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",4327.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18058.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19120.5,
"KNEE ARTHROSCOPY/SURGERY",1529882,CDM,360,RC,29882,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"L COLECTOMY/COLECTMY PRTL W COLOSTOMY",1544208,CDM,360,RC,44208,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,22535,
"L COLECTOMY/COLPROCTOSTOMY",1544207,CDM,360,RC,44207,HCPCS,OUTPATIENT,,,25750,20600,,21887.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5245.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",23175,90,,,,,0,"percent of total billed charges","90% of total billed charges",9012.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",17690.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",14935,58,,,,,0,"percent of total billed charges","58% of total billed charges",5245.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",21887.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",25750,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,25750,
"LAP COLOSTOMY",1544188,CDM,360,RC,44188,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",6000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,6000,
"LAP ENTEROLYSIS",1544180,CDM,360,RC,44180,HCPCS,OUTPATIENT,,,20600,16480,,17510,85,,,,,0,"percent of total billed charges","85% of total billed charges",5150,25,,,,,0,"percent of total billed charges","25% of total billed charges",5150,25,,,,,0,"percent of total billed charges","25% of total billed charges",5150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4196.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",18540,90,,,,,0,"percent of total billed charges","90% of total billed charges",7210,35,,,,,0,"percent of total billed charges","35% of total billed charges",14152.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18540,90,,,,,0,"percent of total billed charges","90% of total billed charges",11948,58,,,,,0,"percent of total billed charges","58% of total billed charges",4196.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17510,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,18540,
"LAP INC HERN RECUR COMP",1549657,CDM,360,RC,,,OUTPATIENT,,,40195,32156,,34165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",10048.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10048.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10048.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8187.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",36175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14068.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",27613.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23313.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",8187.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,36175.5,
"LAP INC HERN REPAIR COMP",1549655,CDM,360,RC,,,OUTPATIENT,,,37985,30388,,32287.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",9496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",9496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7737.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",34186.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13294.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",26095.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",34186.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22031.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7737.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",32287.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,34186.5,
"LAP INC HERNIA REPAIR RECUR",1549656,CDM,360,RC,,,OUTPATIENT,,,40195,32156,,34165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",10048.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10048.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",10048.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8187.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",36175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14068.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",27613.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36175.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23313.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",8187.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34165.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,36175.5,
"LAP ING HERNIA REPAIR INIT",1549650,CDM,360,RC,49650,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"LAP ING HERNIA REPAIR INIT",1549654,CDM,360,RC,,,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,20281.5,
"LAP ING HERNIA REPAIR RECUR",1549651,CDM,360,RC,49651,HCPCS,OUTPATIENT,,,21830,17464,,18555.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5457.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5457.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5457.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4446.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19647,90,,,,,0,"percent of total billed charges","90% of total billed charges",7640.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",14997.21,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19647,90,,,,,0,"percent of total billed charges","90% of total billed charges",12661.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",4446.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18555.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19647,
"LAP P COLECTOMY W REM ILEVM",1544205,CDM,360,RC,44205,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",22535,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,22535,
"LAP PARTIAL COLECTOMY",1544204,CDM,360,RC,44204,HCPCS,OUTPATIENT,,,12875,10300,,10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",11587.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4506.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8845.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",7467.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,12875,
"LAP VENT/ABD HERN PROC COMP",1549653,CDM,360,RC,,,OUTPATIENT,,,22860,18288,,19431,85,,,,,0,"percent of total billed charges","85% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4656.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",20574,90,,,,,0,"percent of total billed charges","90% of total billed charges",8001,35,,,,,0,"percent of total billed charges","35% of total billed charges",15704.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20574,90,,,,,0,"percent of total billed charges","90% of total billed charges",13258.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",4656.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19431,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,20574,
"LAP VENT/ABD HERNIA REPAIR",1549652,CDM,360,RC,,,OUTPATIENT,,,22215,17772,,18882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5553.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4525.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",19993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7775.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15261.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19993.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12884.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",4525.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18882.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,19993.5,
"LAP W EXC/DESTR OVARY PELVIC V LESIONS",1558662,CDM,360,RC,58662,HCPCS,OUTPATIENT,,,20600,16480,,17510,85,,,,,0,"percent of total billed charges","85% of total billed charges",5150,25,,,,,0,"percent of total billed charges","25% of total billed charges",5150,25,,,,,0,"percent of total billed charges","25% of total billed charges",5150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4196.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",18540,90,,,,,0,"percent of total billed charges","90% of total billed charges",7210,35,,,,,0,"percent of total billed charges","35% of total billed charges",14152.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18540,90,,,,,0,"percent of total billed charges","90% of total billed charges",11948,58,,,,,0,"percent of total billed charges","58% of total billed charges",4196.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17510,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,18540,
"LAP; ABD PERIT OMENTUM W ASP CYST",1549322,CDM,360,RC,49322,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"LAP; CHOLECYSTECOMY W CHOLANGIOGR",1547563,CDM,360,RC,47563,HCPCS,OUTPATIENT,,,21890,17512,,18606.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4458.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,958.01,843.05,2969.92,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19701,90,,,,,0,"percent of total billed charges","90% of total billed charges",7661.5,35,,3494.80,3494.80,3494.80,"1 through 10","percent of total billed charges","35% of total billed charges",15038.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19701,90,,,,,0,"percent of total billed charges","90% of total billed charges",12696.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4458.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,4156.70,4156.70,4156.70,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18606.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19701,
"LAP; DX ABDOMEN PERRITONEUM OMENTUM",1549320,CDM,360,RC,49320,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"LAPAROSCOPE PROC INTESTINE",1544238,CDM,360,RC,44238,HCPCS,OUTPATIENT,,,21300,17040,,18105,85,,,,,0,"percent of total billed charges","85% of total billed charges",5325,25,,,,,0,"percent of total billed charges","25% of total billed charges",5325,25,,,,,0,"percent of total billed charges","25% of total billed charges",5325,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4338.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19170,90,,,,,0,"percent of total billed charges","90% of total billed charges",7455,35,,,,,0,"percent of total billed charges","35% of total billed charges",14633.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19170,90,,,,,0,"percent of total billed charges","90% of total billed charges",12354,58,,,,,0,"percent of total billed charges","58% of total billed charges",4338.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18105,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19170,
"LAPAROSCOPY APPENDECTOMY",1544970,CDM,360,RC,44970,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,2698.36,1182.83,3358.02,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"LAPAROSCOPY CHOLECYSTECOMY",1547562,CDM,360,RC,47562,HCPCS,OUTPATIENT,,,25110,20088,,21343.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6277.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5114.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1807.06,640.14,3872.94,20,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",22599,90,,,,,0,"percent of total billed charges","90% of total billed charges",8788.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",17250.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22599,90,,,,,0,"percent of total billed charges","90% of total billed charges",14563.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",5114.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,4156.70,4156.70,4156.70,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21343.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,22599,
"LAPAROSCOPY REMOVE ADNEXA",1558661,CDM,360,RC,58661,HCPCS,OUTPATIENT,,,18025,14420,,15321.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4506.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4506.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4506.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3671.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",16222.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6308.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",12383.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",16222.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10454.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3671.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15321.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,16222.5,
"LAPAROSCOPY; W LYSIS OF ADHESIONS",1558660,CDM,360,RC,58660,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"LAPS ESOPHAGOGASTRIC FUNDOPLASTY",1543280,CDM,360,RC,43280,HCPCS,OUTPATIENT,,,37985,30388,,32287.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",9496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",9496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",9496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7737.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",34186.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13294.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",26095.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",34186.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22031.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7737.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",32287.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,34186.5,
"LAPS MOBIL SPLENIC FL ADDON",1544213,CDM,360,RC,44213,HCPCS,OUTPATIENT,,,8370,6696,,7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",7533,90,,,,,0,"percent of total billed charges","90% of total billed charges",2929.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5750.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4854.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1704.97,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",7114.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8370,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,8370,
"LAPS RPR PARAESOPH HER RPR W/MESH",1543282,CDM,360,RC,43282,HCPCS,OUTPATIENT,,,36375,29100,,30918.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9093.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",9093.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",9093.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7409.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",32737.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12731.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24989.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",32737.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",21097.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",7409.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",30918.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,32737.5,
"MARKER BREAST BIOZORB LP 2CMX2CMX1CM",1570882,CDM,360,RC,C9728,HCPCS,OUTPATIENT,,,5200,4160,,4420,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1616.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1059.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4680,90,,,,,0,"percent of total billed charges","90% of total billed charges",1820,35,,,,,0,"percent of total billed charges","35% of total billed charges",3572.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3016,58,,,,,0,"percent of total billed charges","58% of total billed charges",1059.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4420,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1059.24,4680,
"MARKER BREAST BIOZORB LP 2CMX3CMX1CM",1570883,CDM,360,RC,C9728,HCPCS,OUTPATIENT,,,7600,6080,,6460,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1616.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1548.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6840,90,,,,,0,"percent of total billed charges","90% of total billed charges",2660,35,,,,,0,"percent of total billed charges","35% of total billed charges",5221.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4408,58,,,,,0,"percent of total billed charges","58% of total billed charges",1548.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6460,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,6840,
"MARKER BREAST TISSUE BIOZORB 2CM X 2CM",1570880,CDM,360,RC,C9728,HCPCS,OUTPATIENT,,,5385,4308,,4577.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1616.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1096.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4846.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1884.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3699.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3123.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1096.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4577.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1096.92,4846.5,
"MARKER BREAST TISSUE BIOZORB 2CM X 3CM",1570881,CDM,360,RC,C9728,HCPCS,OUTPATIENT,,,5385,4308,,4577.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1616.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1096.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4846.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1884.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3699.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3123.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1096.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4577.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1096.92,4846.5,
"MARKER BREAST TISSUE BIOZORB 3CM X 3CM",1570884,CDM,360,RC,C9728,HCPCS,OUTPATIENT,,,7600,6080,,6460,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1616.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1548.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6840,90,,,,,0,"percent of total billed charges","90% of total billed charges",2660,35,,,,,0,"percent of total billed charges","35% of total billed charges",5221.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4408,58,,,,,0,"percent of total billed charges","58% of total billed charges",1548.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6460,85,,,,,0,"percent of total billed charges","85% of total billed charges",1243.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1119.05,6840,
"MAST MOD RAD",1519307,CDM,360,RC,19307,HCPCS,OUTPATIENT,,,23630,18904,,20085.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5907.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5907.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5907.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4813.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1169.18,1169.18,1169.18,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",21267,90,,,,,0,"percent of total billed charges","90% of total billed charges",8270.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",16233.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21267,90,,,,,0,"percent of total billed charges","90% of total billed charges",13705.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",4813.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20085.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,21267,
"MAST RADICAL",1519305,CDM,360,RC,19305,HCPCS,OUTPATIENT,,,13845,11076,,11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4845.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9511.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8030.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",13845,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,13845,
"MASTECTOMY PARTIAL W/LN REMOVAL",1519302,CDM,360,RC,19302,HCPCS,OUTPATIENT,,,24920,19936,,21182,85,,,,,0,"percent of total billed charges","85% of total billed charges",6230,25,,,,,0,"percent of total billed charges","25% of total billed charges",6230,25,,,,,0,"percent of total billed charges","25% of total billed charges",6230,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5076.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",22428,90,,,,,0,"percent of total billed charges","90% of total billed charges",8722,35,,,,,0,"percent of total billed charges","35% of total billed charges",17120.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22428,90,,,,,0,"percent of total billed charges","90% of total billed charges",14453.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",5076.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21182,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,22428,
"MASTECTOMY SIMPLE COMPLETE",1519303,CDM,360,RC,19303,HCPCS,OUTPATIENT,,,24980,19984,,21233,85,,,,,0,"percent of total billed charges","85% of total billed charges",6245,25,,,,,0,"percent of total billed charges","25% of total billed charges",6245,25,,,,,0,"percent of total billed charges","25% of total billed charges",6245,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5088.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,2550.00,2550.00,2550.00,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",22482,90,,,,,0,"percent of total billed charges","90% of total billed charges",8743,35,,,,,0,"percent of total billed charges","35% of total billed charges",17161.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22482,90,,,,,0,"percent of total billed charges","90% of total billed charges",14488.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",5088.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21233,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,22482,
"MASTOMY W/EXPLORATION/DRAINAGE ABSCESS",1519020,CDM,360,RC,19020,HCPCS,OUTPATIENT,,,7725,6180,,6566.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1931.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1931.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1931.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1573.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6952.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2703.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",5307.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6952.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4480.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1573.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6566.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6952.5,
MASTOPEXY,1519316,CDM,360,RC,19316,HCPCS,OUTPATIENT,,,22895,18316,,19460.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5723.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5723.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5723.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4663.71,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20605.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8013.25,35,,6176.43,6176.43,6176.43,"1 through 10","percent of total billed charges","35% of total billed charges",15728.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20605.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13279.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",4663.71,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19460.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20605.5,
"MOBILIZATION OF COLON",1544139,CDM,360,RC,44139,HCPCS,OUTPATIENT,,,12875,10300,,10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",11587.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4506.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8845.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",7467.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",12875,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,12875,
"MUSCLE FLAP TRUNK",1515734,CDM,360,RC,15734,HCPCS,OUTPATIENT,,,13520,10816,,11492,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4324.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2754.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,701.51,701.51,1282.29,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3393.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",12168,90,,,,,0,"percent of total billed charges","90% of total billed charges",4732,35,,,,,0,"percent of total billed charges","35% of total billed charges",9288.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2994.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",7841.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",2754.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11492,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,12168,
"MUSCLE-SKIN GRAFT LEG",1515738,CDM,360,RC,15738,HCPCS,OUTPATIENT,,,13025,10420,,11071.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4324.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2653.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3393.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",11722.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4558.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8948.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2994.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",7554.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2653.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11071.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,11722.5,
"NASAL/OROGASTRIC W/TUBE PLMT",1543752,CDM,360,RC,43752,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",325.92,1440,
"NEEDLE BIOPSY LIVER ADD ON",1547001,CDM,360,RC,47001,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",193.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",193.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",193.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",157.87,986.63,
"NEEDLE BIOPSY LYMPH NODES",1538505,CDM,360,RC,38505,HCPCS,OUTPATIENT,,,7000,5600,,5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1750,25,,,,,0,"percent of total billed charges","25% of total billed charges",1750,25,,,,,0,"percent of total billed charges","25% of total billed charges",1750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1425.9,20.37,,964.35,964.35,964.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,2176.58,2176.58,2176.58,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6300,90,,,,,0,"percent of total billed charges","90% of total billed charges",2450,35,,,,,0,"percent of total billed charges","35% of total billed charges",4809,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6300,90,,,,,0,"percent of total billed charges","90% of total billed charges",4060,58,,,,,0,"percent of total billed charges","58% of total billed charges",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6300,
"NIPPLE EXPLORATION",1519110,CDM,360,RC,19110,HCPCS,OUTPATIENT,,,11305,9044,,9609.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2826.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2826.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2826.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2302.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10174.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3956.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7766.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10174.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6556.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2302.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9609.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10174.5,
"NJX AA&/STRD II IH NERVES",1564425,CDM,360,RC,64425,HCPCS,OUTPATIENT,,,2750,2200,,2337.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",560.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2475,90,,,,,0,"percent of total billed charges","90% of total billed charges",962.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1889.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1595,58,,,,,0,"percent of total billed charges","58% of total billed charges",560.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2337.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",560.18,2475,
"NJX AA&/STRD OTHER PN/BRANCH",1564450,CDM,360,RC,64450,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,131.95,131.95,131.95,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,817.66,446.89,1188.43,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,129.32,129.32,129.32,"1 through 10","percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,493.38,493.38,493.38,"1 through 10","fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",509.25,2250,
"NJX NONCMPND SCLRSNT 1 VEIN",1536465,CDM,360,RC,36465,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6750,
"NJX PLATELET PLASMA",1502321,CDM,360,RC,0232T,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,2250,
"OPEN BX OR EXC LN; SUPERFICIAL",1538500,CDM,360,RC,38500,HCPCS,OUTPATIENT,,,14230,11384,,12095.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2898.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12807,90,,,,,0,"percent of total billed charges","90% of total billed charges",4980.5,35,,6407.91,6407.91,6407.91,"1 through 10","percent of total billed charges","35% of total billed charges",9776.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12807,90,,,,,0,"percent of total billed charges","90% of total billed charges",8253.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2898.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12095.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12807,
"OPEN BX/EXC AXILLARY NODE",1538525,CDM,360,RC,38525,HCPCS,OUTPATIENT,,,13845,11076,,11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4845.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9511.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8030.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12460.5,
"OPEN BX/EXC INGUINOFEM NODES",1538531,CDM,360,RC,38531,HCPCS,OUTPATIENT,,,14500,11600,,12325,85,,,,,0,"percent of total billed charges","85% of total billed charges",3625,25,,,,,0,"percent of total billed charges","25% of total billed charges",3625,25,,,,,0,"percent of total billed charges","25% of total billed charges",3625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2953.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,3776.39,3776.39,3776.39,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",13050,90,,,,,0,"percent of total billed charges","90% of total billed charges",5075,35,,,,,0,"percent of total billed charges","35% of total billed charges",9961.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13050,90,,,,,0,"percent of total billed charges","90% of total billed charges",8410,58,,,,,0,"percent of total billed charges","58% of total billed charges",2953.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12325,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,13050,
"OPTX DST RD XART FX/EPI SEP2",1525608,CDM,360,RC,25608,HCPCS,OUTPATIENT,,,28500,22800,,24225,85,,,,,0,"percent of total billed charges","85% of total billed charges",7125,25,,,,,0,"percent of total billed charges","25% of total billed charges",7125,25,,,,,0,"percent of total billed charges","25% of total billed charges",7125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5805.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",25650,90,,,,,0,"percent of total billed charges","90% of total billed charges",9975,35,,,,,0,"percent of total billed charges","35% of total billed charges",19579.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",25650,90,,,,,0,"percent of total billed charges","90% of total billed charges",16530,58,,,,,0,"percent of total billed charges","58% of total billed charges",5805.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",24225,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,25650,
"OR ACUITY LEVEL 1-A 1ST HOUR",1501147,CDM,360,RC,,,OUTPATIENT,,,1260,1008,,1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",315,25,,,,,0,"percent of total billed charges","25% of total billed charges",315,25,,,,,0,"percent of total billed charges","25% of total billed charges",315,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",711.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1134,90,,,,,0,"percent of total billed charges","90% of total billed charges",441,35,,,,,0,"percent of total billed charges","35% of total billed charges",865.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1134,90,,,,,0,"percent of total billed charges","90% of total billed charges",730.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",256.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1071,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.66,1134,
"OR ACUITY LEVEL 1-A X 15 MIN",1501148,CDM,360,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"OR ACUITY LEVEL 1-B 1ST HOUR",1501149,CDM,360,RC,,,OUTPATIENT,,,4120,3296,,3502,85,,,,,0,"percent of total billed charges","85% of total billed charges",1030,25,,,,,0,"percent of total billed charges","25% of total billed charges",1030,25,,,,,0,"percent of total billed charges","25% of total billed charges",1030,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3708,90,,,,,0,"percent of total billed charges","90% of total billed charges",1442,35,,,,,0,"percent of total billed charges","35% of total billed charges",2830.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3708,90,,,,,0,"percent of total billed charges","90% of total billed charges",2389.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3502,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",839.24,3708,
"OR ACUITY LEVEL 1-B X 15 MIN",1501150,CDM,360,RC,,,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"OR ACUITY LEVEL II 1ST HOUR",1501151,CDM,360,RC,,,OUTPATIENT,,,8235,6588,,6999.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2058.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2058.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2058.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1677.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",7411.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2882.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",5657.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7411.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4776.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1677.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6999.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1677.47,7411.5,
"OR ACUITY LEVEL II X 15 MIN",1501152,CDM,360,RC,,,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",158.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",129.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",129.35,571.5,
"OR ACUITY LEVEL III 1ST HOUR",1501153,CDM,360,RC,,,OUTPATIENT,,,12525,10020,,10646.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2551.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",11272.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4383.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8604.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11272.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7264.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2551.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10646.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,11272.5,
"OR ACUITY LEVEL III X 15 MIN",1501154,CDM,360,RC,,,OUTPATIENT,,,845,676,,718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",211.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",477.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",295.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",580.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",760.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",490.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",172.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",718.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",172.13,760.5,
"OR ACUITY LEVEL IV 1ST HOUR",1501155,CDM,360,RC,,,OUTPATIENT,,,15050,12040,,12792.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3762.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3762.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3762.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3065.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",13545,90,,,,,0,"percent of total billed charges","90% of total billed charges",5267.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",10339.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13545,90,,,,,0,"percent of total billed charges","90% of total billed charges",8729,58,,,,,0,"percent of total billed charges","58% of total billed charges",3065.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12792.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,13545,
"OR ACUITY LEVEL IV X 15 MIN",1501156,CDM,360,RC,,,OUTPATIENT,,,1005,804,,854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",204.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",351.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",690.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",582.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",204.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",204.72,904.5,
"PART REMVAL OF ANKLE/HEEL",1528120,CDM,360,RC,28120,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6750,
"PARTIAL AMPUTATION OF TOE",1528825,CDM,360,RC,28825,HCPCS,OUTPATIENT,,,13000,10400,,11050,85,,,,,0,"percent of total billed charges","85% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2648.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11700,90,,,,,0,"percent of total billed charges","90% of total billed charges",4550,35,,,,,0,"percent of total billed charges","35% of total billed charges",8931,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11700,90,,,,,0,"percent of total billed charges","90% of total billed charges",7540,58,,,,,0,"percent of total billed charges","58% of total billed charges",2648.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11050,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11700,
"PARTIAL EXC PHALANX TOE BONE",1528124,CDM,360,RC,28124,HCPCS,OUTPATIENT,,,17065,13652,,14505.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4266.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3476.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",15358.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5972.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",11723.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",15358.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9897.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3476.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14505.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,15358.5,
"PARTIAL MASTECTOMY",1519301,CDM,360,RC,19301,HCPCS,OUTPATIENT,,,13845,11076,,11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2820.23,20.37,,2252.31,2252.31,2252.31,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,1604.34,427.43,2715.31,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4845.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9511.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8030.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2820.23,20.37,,606.47,606.47,606.47,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,2728.18,2728.18,2728.18,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12460.5,
"PARTIAL REMOVAL COLLAR BONE",1523120,CDM,360,RC,23120,HCPCS,OUTPATIENT,,,12500,10000,,10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",3125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",4375,35,,,,,0,"percent of total billed charges","35% of total billed charges",8587.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11250,90,,,,,0,"percent of total billed charges","90% of total billed charges",7250,58,,,,,0,"percent of total billed charges","58% of total billed charges",2546.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10625,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11250,
"PARTIAL REMOVAL OF COLON",1544140,CDM,360,RC,44140,HCPCS,OUTPATIENT,,,19055,15244,,16196.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",3881.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",17149.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6669.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",13090.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",11051.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",3881.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",16196.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",19055,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,19055,
"PARTIAL REMOVAL OF COLON",1544146,CDM,360,RC,44146,HCPCS,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,15000,
"PARTIAL REMOVAL OF FOOT BONE",1528122,CDM,360,RC,28122,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"PARTIAL REMOVAL OF FOOT BONE",1528288,CDM,360,RC,28288,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"PARTIAL REMOVAL OF VULVA",1556620,CDM,360,RC,56620,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"PARTIAL THYROID EXCISION",1560210,CDM,360,RC,60210,HCPCS,OUTPATIENT,,,18540,14832,,15759,85,,,,,0,"percent of total billed charges","85% of total billed charges",4635,25,,,,,0,"percent of total billed charges","25% of total billed charges",4635,25,,,,,0,"percent of total billed charges","25% of total billed charges",4635,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3776.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",16686,90,,,,,0,"percent of total billed charges","90% of total billed charges",6489,35,,,,,0,"percent of total billed charges","35% of total billed charges",12736.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",16686,90,,,,,0,"percent of total billed charges","90% of total billed charges",10753.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3776.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15759,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,16686,
"PARTIAL THYROID EXCISION",1560212,CDM,360,RC,60212,HCPCS,OUTPATIENT,,,19055,15244,,16196.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4763.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4763.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4763.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3881.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",17149.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6669.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",13090.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",17149.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11051.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",3881.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",16196.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,17149.5,
"PERIPROSTH CAPSULECT BREAST",1519371,CDM,360,RC,19371,HCPCS,OUTPATIENT,,,13845,11076,,11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1403.01,1403.01,1549.48,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4845.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9511.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8030.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12460.5,
"PERITONEAL LAVAGE",1549084,CDM,360,RC,49084,HCPCS,OUTPATIENT,,,3605,2884,,3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3244.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1261.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2476.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2090.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",734.34,3244.5,
"PRP I/HERN INIT BLOCK>5 YR",1549507,CDM,360,RC,49507,HCPCS,OUTPATIENT,,,13225,10580,,11241.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3306.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3306.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3306.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2693.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,19.71,19.71,19.71,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11902.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4628.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9085.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11902.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7670.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2693.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11241.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11902.5,
"PRP IST IGUN HRNA 5+",1549505,CDM,360,RC,49505,HCPCS,OUTPATIENT,,,14490,11592,,12316.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2951.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,629.45,629.45,629.45,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",13041,90,,,,,0,"percent of total billed charges","90% of total billed charges",5071.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9954.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13041,90,,,,,0,"percent of total billed charges","90% of total billed charges",8404.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2951.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12316.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,13041,
"PUNCH BX SKIN SINGLE LESION",1511104,CDM,360,RC,11104,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,123.56,123.56,123.56,"1 through 10","percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",325.92,1440,
"PUNCTURE ASPIR CYST BREAST",1519000,CDM,360,RC,19000,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,501.27,501.27,501.27,"1 through 10","fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,6750,
"PUNCTURE DRAINAGE OF LESION",1510160,CDM,360,RC,10160,HCPCS,OUTPATIENT,,,1492,1193.6,,1268.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",303.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1342.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",522.2,35,,,,,0,"percent of total billed charges","35% of total billed charges",1025,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",865.36,58,,,,,0,"percent of total billed charges","58% of total billed charges",303.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1268.2,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",303.92,1342.8,
"RA TRACER ID OF SENTINL NODE",1538792,CDM,360,RC,38792,HCPCS,OUTPATIENT,,,2575,2060,,2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",474.7,130,,,,,0,"fee schedule","130% of CMS OPPS rate",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",372.46,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2317.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",901.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1769.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1493.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",365.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",328.64,2317.5,
"RELEASE PALM CONTRACTURE",1526123,CDM,360,RC,26123,HCPCS,OUTPATIENT,,,12105,9684,,10289.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3026.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3026.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3026.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2465.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10894.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4236.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8316.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10894.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7020.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2465.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10289.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10894.5,
"RELEASE PALM CONTRACTURE ADDON",1526125,CDM,360,RC,26125,HCPCS,OUTPATIENT,,,1545,1236,,1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",386.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",386.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",1390.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",540.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1061.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1390.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",896.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",314.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1313.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",314.72,1390.5,
"REMOVAL INTACT BREAST IMPLANT",1519328,CDM,360,RC,19328,HCPCS,OUTPATIENT,,,13845,11076,,11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4523.76,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3549.41,102,,,,,0,"fee schedule","102% of CMS OPPS rate",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4845.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9511.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3131.83,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8030.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,12460.5,
"REMOVAL OF ANAL FISSURE",1546200,CDM,360,RC,46200,HCPCS,OUTPATIENT,,,11000,8800,,9350,85,,,,,0,"percent of total billed charges","85% of total billed charges",2750,25,,,,,0,"percent of total billed charges","25% of total billed charges",2750,25,,,,,0,"percent of total billed charges","25% of total billed charges",2750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2240.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9900,90,,,,,0,"percent of total billed charges","90% of total billed charges",3850,35,,,,,0,"percent of total billed charges","35% of total billed charges",7557,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9900,90,,,,,0,"percent of total billed charges","90% of total billed charges",6380,58,,,,,0,"percent of total billed charges","58% of total billed charges",2240.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9350,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9900,
"REMOVAL OF BREAST LESION 1+",1519120,CDM,360,RC,19120,HCPCS,OUTPATIENT,,,13845,11076,,11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3461.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4845.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9511.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12460.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8030.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2820.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11768.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12460.5,
"REMOVAL OF BREAST TISSUE",1519300,CDM,360,RC,19300,HCPCS,OUTPATIENT,,,10815,8652,,9192.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2703.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2703.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2703.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2203.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3785.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7429.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6272.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",2203.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9192.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9733.5,
"REMOVAL OF COLON",1544160,CDM,360,RC,44160,HCPCS,OUTPATIENT,,,15000,12000,,12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",13500,90,,,,,0,"percent of total billed charges","90% of total billed charges",5250,35,,,,,0,"percent of total billed charges","35% of total billed charges",10305,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8700,58,,,,,0,"percent of total billed charges","58% of total billed charges",3055.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",12750,85,,,,,0,"percent of total billed charges","85% of total billed charges",15000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,15000,
"REMOVAL OF FOOT LESION",1528090,CDM,360,RC,28090,HCPCS,OUTPATIENT,,,5750,4600,,4887.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1437.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1171.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5175,90,,,,,0,"percent of total billed charges","90% of total billed charges",2012.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3950.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5175,90,,,,,0,"percent of total billed charges","90% of total billed charges",3335,58,,,,,0,"percent of total billed charges","58% of total billed charges",1171.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4887.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5175,
"REMOVAL OF HEMORRHOID CLOT",1546320,CDM,360,RC,46320,HCPCS,OUTPATIENT,,,3865,3092,,3285.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",787.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3478.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1352.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2655.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2241.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",787.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3285.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",787.3,3478.5,
"REMOVAL OF HYDROCELE",1555040,CDM,360,RC,55040,HCPCS,OUTPATIENT,,,13185,10548,,11207.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3296.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3296.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3296.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2685.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11866.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4614.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",9058.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11866.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7647.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2685.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11207.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11866.5,
"REMOVAL OF SKIN TAGS",1511200,CDM,360,RC,11200,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,896.03,896.03,896.03,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,986.63,
"REMOVAL OF SMALL INTESTINE",1544120,CDM,360,RC,44120,HCPCS,OUTPATIENT,,,10000,8000,,8500,85,,,,,0,"percent of total billed charges","85% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2037,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9000,90,,,,,0,"percent of total billed charges","90% of total billed charges",3500,35,,,,,0,"percent of total billed charges","35% of total billed charges",6870,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5800,58,,,,,0,"percent of total billed charges","58% of total billed charges",2037,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8500,85,,,,,0,"percent of total billed charges","85% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,10000,
"REMOVAL OF SPERM LESION",1555520,CDM,360,RC,55520,HCPCS,OUTPATIENT,,,12875,10300,,10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3218.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3218.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3218.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11587.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4506.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8845.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11587.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7467.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2622.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10943.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11587.5,
"REMOVAL OF SWEAT GLAND LESSION",1511471,CDM,360,RC,11471,HCPCS,OUTPATIENT,,,9980,7984,,8483,85,,,,,0,"percent of total billed charges","85% of total billed charges",2495,25,,,,,0,"percent of total billed charges","25% of total billed charges",2495,25,,,,,0,"percent of total billed charges","25% of total billed charges",2495,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2032.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",8982,90,,,,,0,"percent of total billed charges","90% of total billed charges",3493,35,,,,,0,"percent of total billed charges","35% of total billed charges",6856.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8982,90,,,,,0,"percent of total billed charges","90% of total billed charges",5788.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2032.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8483,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,8982,
"REMOVAL OF THYROID",1560252,CDM,360,RC,60252,HCPCS,OUTPATIENT,,,21375,17100,,18168.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4354.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19237.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7481.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",14684.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19237.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12397.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",4354.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18168.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19237.5,
"REMOVAL OF TUNNELED CV CATH",1536590,CDM,360,RC,36590,HCPCS,OUTPATIENT,,,3890,3112,,3306.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1835.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",792.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1439.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3501,90,,,,,0,"percent of total billed charges","90% of total billed charges",1361.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2672.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1270.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2256.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",792.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3306.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",792.39,3501,
"REMOVAL OF TUNNELED CVAD W PORT/PUMP",1736590,CDM,360,RC,36590,HCPCS,OUTPATIENT,,,5115,4092,,4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1835.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1439.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1790.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3514.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1270.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2966.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1411.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4603.5,
"REMOVAL SUBQ RHYTHM MNTR",1533286,CDM,360,RC,33286,HCPCS,OUTPATIENT,,,2900,2320,,2465,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.19,130,,,,,0,"fee schedule","130% of CMS OPPS rate",590.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,115.38,115.38,115.38,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2610,90,,,,,0,"percent of total billed charges","90% of total billed charges",1015,35,,,,,0,"percent of total billed charges","35% of total billed charges",1992.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1682,58,,,,,0,"percent of total billed charges","58% of total billed charges",590.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2465,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,2610,
"REMOVE ARMPIT LYMPH NODES",1538745,CDM,360,RC,38745,HCPCS,OUTPATIENT,,,21890,17512,,18606.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5472.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4458.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19701,90,,,,,0,"percent of total billed charges","90% of total billed charges",7661.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",15038.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19701,90,,,,,0,"percent of total billed charges","90% of total billed charges",12696.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4458.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18606.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19701,
"REMOVE EXT HEM GROUPS 2+",1546250,CDM,360,RC,46250,HCPCS,OUTPATIENT,,,9985,7988,,8487.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2496.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2033.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",8986.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3494.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6859.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8986.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5791.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2033.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8487.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,8986.5,
"REMOVE EXTERNAL EAR PARTIAL",1569110,CDM,360,RC,69110,HCPCS,OUTPATIENT,,,11500,9200,,9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",2875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",4025,35,,,,,0,"percent of total billed charges","35% of total billed charges",7900.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10350,90,,,,,0,"percent of total billed charges","90% of total billed charges",6670,58,,,,,0,"percent of total billed charges","58% of total billed charges",2342.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9775,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10350,
"REMOVE INT/EXT HEM 1 GROUP",1546255,CDM,360,RC,46255,HCPCS,OUTPATIENT,,,10580,8464,,8993,85,,,,,0,"percent of total billed charges","85% of total billed charges",2645,25,,,,,0,"percent of total billed charges","25% of total billed charges",2645,25,,,,,0,"percent of total billed charges","25% of total billed charges",2645,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2155.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9522,90,,,,,0,"percent of total billed charges","90% of total billed charges",3703,35,,,,,0,"percent of total billed charges","35% of total billed charges",7268.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9522,90,,,,,0,"percent of total billed charges","90% of total billed charges",6136.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2155.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8993,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9522,
"REMOVE LIMB NERVE LESION",1564782,CDM,360,RC,64782,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6750,
"REMOVE MANDIBLE CYST COMPLEX",1521046,CDM,360,RC,21046,HCPCS,OUTPATIENT,,,21500,17200,,18275,85,,,,,0,"percent of total billed charges","85% of total billed charges",5375,25,,,,,0,"percent of total billed charges","25% of total billed charges",5375,25,,,,,0,"percent of total billed charges","25% of total billed charges",5375,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4379.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19350,90,,,,,0,"percent of total billed charges","90% of total billed charges",7525,35,,,,,0,"percent of total billed charges","35% of total billed charges",14770.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19350,90,,,,,0,"percent of total billed charges","90% of total billed charges",12470,58,,,,,0,"percent of total billed charges","58% of total billed charges",4379.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18275,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19350,
"REMOVE MESH FROM ABD WALL",1511008,CDM,360,RC,11008,HCPCS,OUTPATIENT,,,1230,984,,1045.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",250.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1107,90,,,,,0,"percent of total billed charges","90% of total billed charges",430.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",845.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",713.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",250.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1045.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1230,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",250.55,1230,
"REMOVE PILONIDAL CYST COMPL",1511772,CDM,360,RC,11772,HCPCS,OUTPATIENT,,,9250,7400,,7862.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1884.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",8325,90,,,,,0,"percent of total billed charges","90% of total billed charges",3237.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6354.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8325,90,,,,,0,"percent of total billed charges","90% of total billed charges",5365,58,,,,,0,"percent of total billed charges","58% of total billed charges",1884.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7862.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,8325,
"REMOVE PILONIDAL CYST EXTEN",1511771,CDM,360,RC,11771,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,480.12,480.12,480.12,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"REMOVE PILONIDAL CYST SIMPLE",1511770,CDM,360,RC,11770,HCPCS,OUTPATIENT,,,10350,8280,,8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2587.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,2244.82,597.11,2648.84,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",3622.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7110.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9315,90,,,,,0,"percent of total billed charges","90% of total billed charges",6003,58,,,,,0,"percent of total billed charges","58% of total billed charges",2108.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8797.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9315,
"REMOVE VAGINA TISSUE PART",1557107,CDM,360,RC,57107,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"REMOVE WRIST TENDON LESION",1525111,CDM,360,RC,25111,HCPCS,OUTPATIENT,,,6500,5200,,5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,948.40,948.40,948.40,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",2275,35,,,,,0,"percent of total billed charges","35% of total billed charges",4465.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",3770,58,,,,,0,"percent of total billed charges","58% of total billed charges",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5850,
"REP INIT FEM HERNIA REDUCABLE; INCARCE",1549553,CDM,360,RC,49553,HCPCS,OUTPATIENT,,,14370,11496,,12214.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3592.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3592.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3592.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2927.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12933,90,,,,,0,"percent of total billed charges","90% of total billed charges",5029.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9872.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12933,90,,,,,0,"percent of total billed charges","90% of total billed charges",8334.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",2927.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12214.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12933,
"REPAIR FINGER/HAND TENDON",1526356,CDM,360,RC,26356,HCPCS,OUTPATIENT,,,12975,10380,,11028.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2643.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11677.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4541.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8913.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11677.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7525.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2643.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11028.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11677.5,
"REPAIR FOREARM TENDON/MUSCLE",1525272,CDM,360,RC,25272,HCPCS,OUTPATIENT,,,11925,9540,,10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2981.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4173.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8192.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6916.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2429.12,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10136.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10732.5,
"REPAIR FOREARM TENDON/MUSCLE SEC 1 EA TD",1525263,CDM,360,RC,25263,HCPCS,OUTPATIENT,,,26458.52,21166.82,,22489.74,85,,,,,0,"percent of total billed charges","85% of total billed charges",6614.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",6614.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",6614.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5389.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",23812.67,90,,,,,0,"percent of total billed charges","90% of total billed charges",9260.48,35,,,,,0,"percent of total billed charges","35% of total billed charges",18177,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23812.67,90,,,,,0,"percent of total billed charges","90% of total billed charges",15345.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",5389.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22489.74,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,23812.67,
"REPAIR INITIAL INCISIONAL HERNIA INCARC",1549561,CDM,360,RC,,,OUTPATIENT,,,14360,11488,,12206,85,,,,,0,"percent of total billed charges","85% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2925.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",12924,90,,,,,0,"percent of total billed charges","90% of total billed charges",5026,35,,,,,0,"percent of total billed charges","35% of total billed charges",9865.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12924,90,,,,,0,"percent of total billed charges","90% of total billed charges",8328.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2925.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12206,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,12924,
"REPAIR NERVE ADD-ON",1564832,CDM,360,RC,64832,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",625,25,,,,,0,"percent of total billed charges","25% of total billed charges",625,25,,,,,0,"percent of total billed charges","25% of total billed charges",625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",509.25,2250,
"REPAIR OF DIGIT NERVE",1564831,CDM,360,RC,64831,HCPCS,OUTPATIENT,,,7800,6240,,6630,85,,,,,0,"percent of total billed charges","85% of total billed charges",1950,25,,,,,0,"percent of total billed charges","25% of total billed charges",1950,25,,,,,0,"percent of total billed charges","25% of total billed charges",1950,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1588.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",7020,90,,,,,0,"percent of total billed charges","90% of total billed charges",2730,35,,,,,0,"percent of total billed charges","35% of total billed charges",5358.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7020,90,,,,,0,"percent of total billed charges","90% of total billed charges",4524,58,,,,,0,"percent of total billed charges","58% of total billed charges",1588.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6630,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,7020,
"REPAIR UMBILICAL HERNIA",1549585,CDM,360,RC,,,OUTPATIENT,,,14490,11592,,12316.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2951.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",13041,90,,,,,0,"percent of total billed charges","90% of total billed charges",5071.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9954.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13041,90,,,,,0,"percent of total billed charges","90% of total billed charges",8404.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2951.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12316.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,13041,
"REPAIR UMBILICAL HERNIA",1549595,CDM,360,RC,49595,HCPCS,OUTPATIENT,,,14490,11592,,12316.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3622.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2951.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",13041,90,,,,,0,"percent of total billed charges","90% of total billed charges",5071.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9954.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13041,90,,,,,0,"percent of total billed charges","90% of total billed charges",8404.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2951.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12316.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,13041,
"REPAIR/REVISE WRIST JOINT",1525320,CDM,360,RC,25320,HCPCS,OUTPATIENT,,,26450,21160,,22482.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6612.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6612.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6612.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5387.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",23805,90,,,,,0,"percent of total billed charges","90% of total billed charges",9257.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",18171.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23805,90,,,,,0,"percent of total billed charges","90% of total billed charges",15341,58,,,,,0,"percent of total billed charges","58% of total billed charges",5387.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22482.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,23805,
"REPLACE TUNNELED CV CATH",1536582,CDM,360,RC,36582,HCPCS,OUTPATIENT,,,12105,9684,,10289.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",3026.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3026.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",3026.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2465.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10894.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4236.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",8316.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10894.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7020.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2465.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10289.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10894.5,
"REPLCMT TISS XPNDR PERM IMP",1511970,CDM,360,RC,11970,HCPCS,OUTPATIENT,,,26355,21084,,22401.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6588.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",6588.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",6588.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5368.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",23719.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9224.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",18105.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23719.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15285.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5368.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22401.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,23719.5,
"REREPAIR ING HERNIA BLOCKED",1549521,CDM,360,RC,49521,HCPCS,OUTPATIENT,,,14175,11340,,12048.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2887.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12757.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4961.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",9738.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12757.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8221.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2887.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12048.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12757.5,
"REREPAIR ING HERNIA REDUCE",1549520,CDM,360,RC,49520,HCPCS,OUTPATIENT,,,14175,11340,,12048.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2887.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12757.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4961.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",9738.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12757.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8221.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2887.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12048.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12757.5,
"RESECT BACK TUM 5 CM/>",1521936,CDM,360,RC,21936,HCPCS,OUTPATIENT,,,10850,8680,,9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2712.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",3797.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",7453.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9765,90,,,,,0,"percent of total billed charges","90% of total billed charges",6293,58,,,,,0,"percent of total billed charges","58% of total billed charges",2210.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9222.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9765,
"RESECT NECK TUMOR 5CM/>",1521558,CDM,360,RC,21558,HCPCS,OUTPATIENT,,,10465,8372,,8895.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2616.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2616.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2616.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2131.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3662.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7189.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6069.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",2131.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8895.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9418.5,
"REVISE HAND/FOOT NERVE",1564704,CDM,360,RC,64704,HCPCS,OUTPATIENT,,,7500,6000,,6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",1875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",2625,35,,,,,0,"percent of total billed charges","35% of total billed charges",5152.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6750,90,,,,,0,"percent of total billed charges","90% of total billed charges",4350,58,,,,,0,"percent of total billed charges","58% of total billed charges",1527.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6750,
"REVISE ULNAR NERVE AT WRIST",1564719,CDM,360,RC,64719,HCPCS,OUTPATIENT,,,7358.52,5886.82,,6254.74,85,,,,,0,"percent of total billed charges","85% of total billed charges",1839.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",1839.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",1839.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1498.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6622.67,90,,,,,0,"percent of total billed charges","90% of total billed charges",2575.48,35,,,,,0,"percent of total billed charges","35% of total billed charges",5055.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6622.67,90,,,,,0,"percent of total billed charges","90% of total billed charges",4267.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",1498.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6254.74,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6622.67,
"REVISION RECONSTRUCTED BREAST",1519380,CDM,360,RC,19380,HCPCS,OUTPATIENT,,,23820,19056,,20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",5955,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,15300.00,15300.00,15300.00,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",8337,35,,,,,0,"percent of total billed charges","35% of total billed charges",16364.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21438,90,,,,,0,"percent of total billed charges","90% of total billed charges",13815.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4852.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,4646.22,4646.22,4646.22,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20247,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,21438,
"REVJ PERI-IMPLT CAPSULE BRST",1519370,CDM,360,RC,19370,HCPCS,OUTPATIENT,,,16000,12800,,13600,85,,,,,0,"percent of total billed charges","85% of total billed charges",4000,25,,,,,0,"percent of total billed charges","25% of total billed charges",4000,25,,,,,0,"percent of total billed charges","25% of total billed charges",4000,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3259.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",14400,90,,,,,0,"percent of total billed charges","90% of total billed charges",5600,35,,,,,0,"percent of total billed charges","35% of total billed charges",10992,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14400,90,,,,,0,"percent of total billed charges","90% of total billed charges",9280,58,,,,,0,"percent of total billed charges","58% of total billed charges",3259.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13600,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,14400,
"RMVL RUPTURED BREAST IMPLANT",1519330,CDM,360,RC,19330,HCPCS,OUTPATIENT,,,12900,10320,,10965,85,,,,,0,"percent of total billed charges","85% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4523.76,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2627.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,793.05,793.05,793.05,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3549.41,102,,,,,0,"fee schedule","102% of CMS OPPS rate",11610,90,,,,,0,"percent of total billed charges","90% of total billed charges",4515,35,,,,,0,"percent of total billed charges","35% of total billed charges",8862.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3131.83,90,,,,,0,"fee schedule","90% of CMS OPPS rate",7482,58,,,,,0,"percent of total billed charges","58% of total billed charges",2627.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",10965,85,,,,,0,"percent of total billed charges","85% of total billed charges",3479.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,11610,
"RPR AA HRN 1ST < 3 CM RDC",1549591,CDM,360,RC,49591,HCPCS,OUTPATIENT,,,14175,11340,,12048.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3543.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2887.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,547.87,289.64,1655.55,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12757.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4961.25,35,,328.82,328.82,328.82,"1 through 10","percent of total billed charges","35% of total billed charges",9738.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12757.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8221.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2887.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,2514.28,2514.28,2514.28,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12048.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12757.5,
"RPR AA HRN 1ST < 3 NCR/STRN",1549592,CDM,360,RC,49592,HCPCS,OUTPATIENT,,,21000,16800,,17850,85,,,,,0,"percent of total billed charges","85% of total billed charges",5250,25,,,,,0,"percent of total billed charges","25% of total billed charges",5250,25,,,,,0,"percent of total billed charges","25% of total billed charges",5250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4277.7,20.37,,198.91,198.91,198.91,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,1549.18,557.84,2788.52,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",18900,90,,,,,0,"percent of total billed charges","90% of total billed charges",7350,35,,310.00,310.00,310.00,"1 through 10","percent of total billed charges","35% of total billed charges",14427,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18900,90,,,,,0,"percent of total billed charges","90% of total billed charges",12180,58,,,,,0,"percent of total billed charges","58% of total billed charges",4277.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17850,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,18900,
"RPR AA HRN 1ST 3-10 NCR/STRN",1549594,CDM,360,RC,49594,HCPCS,OUTPATIENT,,,20850,16680,,17722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4247.15,20.37,,2097.13,2097.13,2097.13,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,2383.70,1268.87,3498.53,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",18765,90,,,,,0,"percent of total billed charges","90% of total billed charges",7297.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",14323.95,68.7,,4155.35,4155.35,4155.35,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18765,90,,,,,0,"percent of total billed charges","90% of total billed charges",12093,58,,,,,0,"percent of total billed charges","58% of total billed charges",4247.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,18765,
"RPR AA HRN 1ST 3-10 RDC",1549593,CDM,360,RC,49593,HCPCS,OUTPATIENT,,,14500,11600,,12325,85,,,,,0,"percent of total billed charges","85% of total billed charges",3625,25,,,,,0,"percent of total billed charges","25% of total billed charges",3625,25,,,,,0,"percent of total billed charges","25% of total billed charges",3625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2953.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",13050,90,,,,,0,"percent of total billed charges","90% of total billed charges",5075,35,,,,,0,"percent of total billed charges","35% of total billed charges",9961.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13050,90,,,,,0,"percent of total billed charges","90% of total billed charges",8410,58,,,,,0,"percent of total billed charges","58% of total billed charges",2953.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,4445.52,4445.52,4445.52,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12325,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,13050,
"RPR AA HRN RCR < 3 NCR/STRN",1549614,CDM,360,RC,49614,HCPCS,OUTPATIENT,,,20850,16680,,17722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",5212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5212.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4247.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",18765,90,,,,,0,"percent of total billed charges","90% of total billed charges",7297.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",14323.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18765,90,,,,,0,"percent of total billed charges","90% of total billed charges",12093,58,,,,,0,"percent of total billed charges","58% of total billed charges",4247.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,18765,
"RPR AA HRN RCR < 3 RDC",1549613,CDM,360,RC,49613,HCPCS,OUTPATIENT,,,13200,10560,,11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",3300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",4620,35,,,,,0,"percent of total billed charges","35% of total billed charges",9068.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11880,90,,,,,0,"percent of total billed charges","90% of total billed charges",7656,58,,,,,0,"percent of total billed charges","58% of total billed charges",2688.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11220,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11880,
"RPR TDN/MUSC UPR A/E EACH",1524341,CDM,360,RC,24341,HCPCS,OUTPATIENT,,,26500,21200,,22525,85,,,,,0,"percent of total billed charges","85% of total billed charges",6625,25,,,,,0,"percent of total billed charges","25% of total billed charges",6625,25,,,,,0,"percent of total billed charges","25% of total billed charges",6625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5398.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",23850,90,,,,,0,"percent of total billed charges","90% of total billed charges",9275,35,,,,,0,"percent of total billed charges","35% of total billed charges",18205.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23850,90,,,,,0,"percent of total billed charges","90% of total billed charges",15370,58,,,,,0,"percent of total billed charges","58% of total billed charges",5398.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,23850,
"RPR UMBIL HERN BLOCK 5+ YR",1549587,CDM,360,RC,,,OUTPATIENT,,,14230,11384,,12095.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3557.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2898.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",12807,90,,,,,0,"percent of total billed charges","90% of total billed charges",4980.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",9776.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12807,90,,,,,0,"percent of total billed charges","90% of total billed charges",8253.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2898.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12095.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,12807,
"RPR VENTRAL HERN INIT REDUC",1549560,CDM,360,RC,,,OUTPATIENT,,,14360,11488,,12206,85,,,,,0,"percent of total billed charges","85% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",3590,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2925.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",12924,90,,,,,0,"percent of total billed charges","90% of total billed charges",5026,35,,,,,0,"percent of total billed charges","35% of total billed charges",9865.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12924,90,,,,,0,"percent of total billed charges","90% of total billed charges",8328.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2925.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12206,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,12924,
"RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA",1526370,CDM,360,RC,26370,HCPCS,OUTPATIENT,,,12975,10380,,11028.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3243.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2643.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11677.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4541.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",8913.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11677.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7525.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2643.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11028.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11677.5,
"SEC CLSR SURG WND/DEHSN XTN",1513160,CDM,360,RC,13160,HCPCS,OUTPATIENT,,,7000,5600,,5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6300,90,,,,,0,"percent of total billed charges","90% of total billed charges",2450,35,,,,,0,"percent of total billed charges","35% of total billed charges",4809,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4060,58,,,,,0,"percent of total billed charges","58% of total billed charges",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6300,
"SGMDSC W/BAND LIGATION",1545350,CDM,360,RC,45350,HCPCS,OUTPATIENT,,,4500,3600,,3825,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",916.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4050,90,,,,,0,"percent of total billed charges","90% of total billed charges",1575,35,,,,,0,"percent of total billed charges","35% of total billed charges",3091.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2610,58,,,,,0,"percent of total billed charges","58% of total billed charges",916.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3825,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4050,
"SHO ARTHR SRG LMTD DRBDMT",1529822,CDM,360,RC,29822,HCPCS,OUTPATIENT,,,15710,12568,,13353.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3927.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3927.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3927.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3200.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",14139,90,,,,,0,"percent of total billed charges","90% of total billed charges",5498.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",10792.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14139,90,,,,,0,"percent of total billed charges","90% of total billed charges",9111.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",3200.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13353.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,14139,
"SHO ARTHRS SRG BICP TENODSIS",1529828,CDM,360,RC,29828,HCPCS,OUTPATIENT,,,20085,16068,,17072.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5021.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5021.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5021.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4091.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",18076.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7029.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",13798.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18076.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11649.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4091.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17072.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,18076.5,
"SHO ARTHRS SRG CAPSULORPAPHY",1529806,CDM,360,RC,29806,HCPCS,OUTPATIENT,,,28585,22868,,24297.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",7146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",7146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",7146.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5822.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",25726.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10004.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",19637.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",25726.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",16579.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",5822.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",24297.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,25726.5,
"SHO ARTHRS SRG DECOMPRESSION",1529826,CDM,360,RC,29826,HCPCS,OUTPATIENT,,,620,496,,527,85,,,,,0,"percent of total billed charges","85% of total billed charges",155,25,,,,,0,"percent of total billed charges","25% of total billed charges",155,25,,,,,0,"percent of total billed charges","25% of total billed charges",155,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",126.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",558,90,,,,,0,"percent of total billed charges","90% of total billed charges",217,35,,,,,0,"percent of total billed charges","35% of total billed charges",425.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",558,90,,,,,0,"percent of total billed charges","90% of total billed charges",359.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",126.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",527,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",126.29,986.63,
"SHO ARTHRS SRG DSTL CLAVICLC",1529824,CDM,360,RC,29824,HCPCS,OUTPATIENT,,,17770,14216,,15104.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4442.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",4442.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",4442.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3619.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",15993,90,,,,,0,"percent of total billed charges","90% of total billed charges",6219.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",12207.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",15993,90,,,,,0,"percent of total billed charges","90% of total billed charges",10306.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",3619.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15104.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,15993,
"SHO ARTHRS SRG LSS RESCJ ADS",1529825,CDM,360,RC,29825,HCPCS,OUTPATIENT,,,18390,14712,,15631.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",4597.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",4597.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",4597.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3746.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",16551,90,,,,,0,"percent of total billed charges","90% of total billed charges",6436.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",12633.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",16551,90,,,,,0,"percent of total billed charges","90% of total billed charges",10666.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3746.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",15631.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,16551,
"SHO ARTHRS SRG XTINSV DRBDMT",1529823,CDM,360,RC,29823,HCPCS,OUTPATIENT,,,13500,10800,,11475,85,,,,,0,"percent of total billed charges","85% of total billed charges",3375,25,,,,,0,"percent of total billed charges","25% of total billed charges",3375,25,,,,,0,"percent of total billed charges","25% of total billed charges",3375,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2749.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",12150,90,,,,,0,"percent of total billed charges","90% of total billed charges",4725,35,,,,,0,"percent of total billed charges","35% of total billed charges",9274.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12150,90,,,,,0,"percent of total billed charges","90% of total billed charges",7830,58,,,,,0,"percent of total billed charges","58% of total billed charges",2749.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11475,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,12150,
"SIGMODOSCOPY W/ABLATION",1745346,CDM,360,RC,45346,HCPCS,OUTPATIENT,,,4330,3464,,3680.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",882.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3897,90,,,,,0,"percent of total billed charges","90% of total billed charges",1515.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2974.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2511.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",882.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3680.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,3897,
"SKIN SPLIT A-GRAFT F/N/HF/G-ADD",1515121,CDM,360,RC,15121,HCPCS,OUTPATIENT,,,525,420,,446.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",106.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",183.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",360.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",106.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",446.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",106.94,986.63,
"SKIN SPLIT A-GRFT",1515120,CDM,360,RC,15120,HCPCS,OUTPATIENT,,,14935,11948,,12694.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4324.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",3042.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3393.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",13441.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5227.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10260.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2994.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8662.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",3042.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12694.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,13441.5,
"SKIN SPLIT GRFT ADDON",1515101,CDM,360,RC,15101,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,986.63,
"SKIN SPLIT GRFT TRUNK/ARM/LEG",1515100,CDM,360,RC,15100,HCPCS,OUTPATIENT,,,7210,5768,,6128.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1468.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6489,90,,,,,0,"percent of total billed charges","90% of total billed charges",2523.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4953.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4181.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1468.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,651.62,651.62,651.62,"1 through 10","fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6128.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6489,
"SUCTION LIPECTOMY TRUNK",1515877,CDM,360,RC,15877,HCPCS,OUTPATIENT,,,14935,11948,,12694.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4324.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",3042.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3393.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",13441.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5227.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10260.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2994.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8662.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",3042.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12694.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,13441.5,
"SURG DX EXAM ANORECTAL",1545990,CDM,360,RC,45990,HCPCS,OUTPATIENT,,,10275,8220,,8733.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2568.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2093.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1762.01,1762.01,1762.01,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3596.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7058.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5959.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2093.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8733.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9247.5,
"SURGICAL ARTHROSCOPY SHOLDER W/ROTATOR",1529827,CDM,360,RC,29827,HCPCS,OUTPATIENT,,,32960,26368,,28016,85,,,,,0,"percent of total billed charges","85% of total billed charges",8240,25,,,,,0,"percent of total billed charges","25% of total billed charges",8240,25,,,,,0,"percent of total billed charges","25% of total billed charges",8240,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6713.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",29664,90,,,,,0,"percent of total billed charges","90% of total billed charges",11536,35,,,,,0,"percent of total billed charges","35% of total billed charges",22643.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",29664,90,,,,,0,"percent of total billed charges","90% of total billed charges",19116.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",6713.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",28016,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,29664,
"SUTURE SMALL INTESTINE",1544602,CDM,360,RC,44602,HCPCS,OUTPATIENT,,,10000,8000,,8500,85,,,,,0,"percent of total billed charges","85% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2037,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9000,90,,,,,0,"percent of total billed charges","90% of total billed charges",3500,35,,,,,0,"percent of total billed charges","35% of total billed charges",6870,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5800,58,,,,,0,"percent of total billed charges","58% of total billed charges",2037,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8500,85,,,,,0,"percent of total billed charges","85% of total billed charges",10000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",862.48,10000,
"TEMPORAL ARTERY PROCEDURE",1537609,CDM,360,RC,37609,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5400,
"THYROIDECTOMY RMVL REM TISS FLWG PRTL RM",1560260,CDM,360,RC,60260,HCPCS,OUTPATIENT,,,21500,17200,,18275,85,,,,,0,"percent of total billed charges","85% of total billed charges",5375,25,,,,,0,"percent of total billed charges","25% of total billed charges",5375,25,,,,,0,"percent of total billed charges","25% of total billed charges",5375,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4379.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",19350,90,,,,,0,"percent of total billed charges","90% of total billed charges",7525,35,,,,,0,"percent of total billed charges","35% of total billed charges",14770.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19350,90,,,,,0,"percent of total billed charges","90% of total billed charges",12470,58,,,,,0,"percent of total billed charges","58% of total billed charges",4379.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18275,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,19350,
"THYROIDECTOMY TOTAL",1560240,CDM,360,RC,60240,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,2449.02,1309.88,3588.16,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"TIS TRNFR ADDL 30 SQCM",1514302,CDM,360,RC,14302,HCPCS,OUTPATIENT,,,1240,992,,1054,85,,,,,0,"percent of total billed charges","85% of total billed charges",310,25,,,,,0,"percent of total billed charges","25% of total billed charges",310,25,,,,,0,"percent of total billed charges","25% of total billed charges",310,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",252.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",1116,90,,,,,0,"percent of total billed charges","90% of total billed charges",434,35,,,,,0,"percent of total billed charges","35% of total billed charges",851.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1116,90,,,,,0,"percent of total billed charges","90% of total billed charges",719.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",252.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1054,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",252.59,1116,
"TIS TRNFR ANY 30-60 SQ CM",1514301,CDM,360,RC,14301,HCPCS,OUTPATIENT,,,14935,11948,,12694.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4324.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",3042.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1778.25,916.86,2639.63,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",3393.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",13441.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5227.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10260.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2994.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8662.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",3042.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3326.87,100,,2608.26,2608.26,2608.26,"1 through 10","fee schedule","100% of CMS OPPS rate",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12694.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3326.87,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,13441.5,
"TIS TRNFR S/A/L 10.3-30SQCM",1514021,CDM,360,RC,14021,HCPCS,OUTPATIENT,,,7000,5600,,5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,856.80,856.80,856.80,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6300,90,,,,,0,"percent of total billed charges","90% of total billed charges",2450,35,,,,,0,"percent of total billed charges","35% of total billed charges",4809,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4060,58,,,,,0,"percent of total billed charges","58% of total billed charges",1425.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5950,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6300,
"TIS TRNFR TRUNK 10 SQ CM/<",1514000,CDM,360,RC,14000,HCPCS,OUTPATIENT,,,6925,5540,,5886.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1410.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6232.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2423.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4757.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4016.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1410.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5886.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6232.5,
"TIS TRNFR TRUNK 10.1-30SQCM",1514001,CDM,360,RC,14001,HCPCS,OUTPATIENT,,,6925,5540,,5886.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1410.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6232.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2423.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4757.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4016.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1410.62,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5886.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6232.5,
"TISS XPNDR BRST RECNSTJ",1519357,CDM,360,RC,19357,HCPCS,OUTPATIENT,,,67405,53924,,57294.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16851.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16851.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16851.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13730.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,19125.00,19125.00,19125.00,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",60664.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",23591.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",46307.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",60664.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",39094.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",13730.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",57294.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,60664.5,
"TOTAL THYROID LOBECTOMY UNILATERAL",1560220,CDM,360,RC,60220,HCPCS,OUTPATIENT,,,22860,18288,,19431,85,,,,,0,"percent of total billed charges","85% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4656.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20574,90,,,,,0,"percent of total billed charges","90% of total billed charges",8001,35,,,,,0,"percent of total billed charges","35% of total billed charges",15704.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20574,90,,,,,0,"percent of total billed charges","90% of total billed charges",13258.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",4656.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19431,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20574,
"TOTAL THYROIDLOBECTOMY; W CSL",1560225,CDM,360,RC,60225,HCPCS,OUTPATIENT,,,22860,18288,,19431,85,,,,,0,"percent of total billed charges","85% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",5715,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4656.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20574,90,,,,,0,"percent of total billed charges","90% of total billed charges",8001,35,,,,,0,"percent of total billed charges","35% of total billed charges",15704.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20574,90,,,,,0,"percent of total billed charges","90% of total billed charges",13258.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",4656.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19431,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20574,
"TREAT LOWER LEG JOINT",1527829,CDM,360,RC,27829,HCPCS,OUTPATIENT,,,26360,21088,,22406,85,,,,,0,"percent of total billed charges","85% of total billed charges",6590,25,,,,,0,"percent of total billed charges","25% of total billed charges",6590,25,,,,,0,"percent of total billed charges","25% of total billed charges",6590,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5369.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",23724,90,,,,,0,"percent of total billed charges","90% of total billed charges",9226,35,,,,,0,"percent of total billed charges","35% of total billed charges",18109.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23724,90,,,,,0,"percent of total billed charges","90% of total billed charges",15288.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",5369.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22406,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,23724,
"TREAT METACARPAL FRACTURE",1526608,CDM,360,RC,26608,HCPCS,OUTPATIENT,,,13000,10400,,11050,85,,,,,0,"percent of total billed charges","85% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",3250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2648.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",11700,90,,,,,0,"percent of total billed charges","90% of total billed charges",4550,35,,,,,0,"percent of total billed charges","35% of total billed charges",8931,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",11700,90,,,,,0,"percent of total billed charges","90% of total billed charges",7540,58,,,,,0,"percent of total billed charges","58% of total billed charges",2648.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11050,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,11700,
"TREATMENT OF ANKLE FRACTURE",1527792,CDM,360,RC,27792,HCPCS,OUTPATIENT,,,26360,21088,,22406,85,,,,,0,"percent of total billed charges","85% of total billed charges",6590,25,,,,,0,"percent of total billed charges","25% of total billed charges",6590,25,,,,,0,"percent of total billed charges","25% of total billed charges",6590,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5369.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",23724,90,,,,,0,"percent of total billed charges","90% of total billed charges",9226,35,,,,,0,"percent of total billed charges","35% of total billed charges",18109.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23724,90,,,,,0,"percent of total billed charges","90% of total billed charges",15288.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",5369.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22406,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,23724,
"TREATMENT OF ANKLE FRACTURE",1527814,CDM,360,RC,27814,HCPCS,OUTPATIENT,,,27500,22000,,23375,85,,,,,0,"percent of total billed charges","85% of total billed charges",6875,25,,,,,0,"percent of total billed charges","25% of total billed charges",6875,25,,,,,0,"percent of total billed charges","25% of total billed charges",6875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5601.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",24750,90,,,,,0,"percent of total billed charges","90% of total billed charges",9625,35,,,,,0,"percent of total billed charges","35% of total billed charges",18892.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",24750,90,,,,,0,"percent of total billed charges","90% of total billed charges",15950,58,,,,,0,"percent of total billed charges","58% of total billed charges",5601.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",23375,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,24750,
"UNLISTED LAPAROSCOPY ABD PERIT OMENT",1549329,CDM,360,RC,49329,HCPCS,OUTPATIENT,,,22825,18260,,19401.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",5706.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5706.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",5706.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4649.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20542.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7988.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",15680.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20542.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13238.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",4649.45,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19401.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20542.5,
"UNLISTED LAPAROSCOPY ESOPHAGUS",1543289,CDM,360,RC,43289,HCPCS,OUTPATIENT,,,22535,18028,,19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5633.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7887.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15481.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20281.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",13070.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4590.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19154.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,20281.5,
"UNLISTED PROCEDURE ANUS",1546999,CDM,360,RC,46999,HCPCS,OUTPATIENT,,,3605,2884,,3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3244.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1261.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2476.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2090.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",734.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3064.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",734.34,3244.5,
"UNLISTED PROCEDURE COLON",1545399,CDM,360,RC,45399,HCPCS,OUTPATIENT,,,3750,3000,,3187.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",763.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3375,90,,,,,0,"percent of total billed charges","90% of total billed charges",1312.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2576.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2175,58,,,,,0,"percent of total billed charges","58% of total billed charges",763.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3187.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,3375,
"WOUND PREP ADDL 100 CM",1515003,CDM,360,RC,15003,HCPCS,OUTPATIENT,,,1500,1200,,1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",375,25,,,,,0,"percent of total billed charges","25% of total billed charges",375,25,,,,,0,"percent of total billed charges","25% of total billed charges",375,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",525,35,,,,,0,"percent of total billed charges","35% of total billed charges",1030.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",870,58,,,,,0,"percent of total billed charges","58% of total billed charges",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",305.55,1350,
"WOUND PREP F/N/HF/G",1515004,CDM,360,RC,15004,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,2250,
"WOUND PREP F/N/HF/G ADDL CM",1515005,CDM,360,RC,15005,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",152.78,986.63,
"WOUND PREP TRK/ARM/LEG",1515002,CDM,360,RC,15002,HCPCS,OUTPATIENT,,,7316,5852.8,,6218.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1490.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,611.67,611.67,611.67,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6584.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",2560.6,35,,,,,0,"percent of total billed charges","35% of total billed charges",5026.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4243.28,58,,,,,0,"percent of total billed charges","58% of total billed charges",1490.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,651.62,651.62,651.62,"1 through 10","fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6218.6,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6584.4,
"G TUBE REPLACEMENT",1743760,CDM,361,RC,,,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,630,
"G TUBE REPLACEMENT",4043760,CDM,361,RC,,,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",175,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",142.59,630,
"ANES INJ EPID BLOOD CLOT",1862273,CDM,379,RC,62273,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,3015,
"ANES LOWER ENDOSCOPIC PRO",1800810,CDM,379,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.26,63,
"ANES NERVE BLOCK DIAG OR THERAPEUTIC",1801991,CDM,379,RC,,,OUTPATIENT,,,2680,2144,,2278,85,,,,,0,"percent of total billed charges","85% of total billed charges",670,25,,,,,0,"percent of total billed charges","25% of total billed charges",670,25,,,,,0,"percent of total billed charges","25% of total billed charges",670,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",545.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2412,90,,,,,0,"percent of total billed charges","90% of total billed charges",938,35,,,,,0,"percent of total billed charges","35% of total billed charges",1841.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2412,90,,,,,0,"percent of total billed charges","90% of total billed charges",1554.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",545.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",545.92,2412,
"ANES UPPER GASTROINTESTIONAL",1800740,CDM,379,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CONSCIOUS SEDATION SCOPES",1700740,CDM,379,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"BB CONVALESCENT PLASMA UNIT",3109018,CDM,390,RC,P9017,HCPCS,OUTPATIENT,,,3090,2472,,2626.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",109.57,130,,,,,0,"fee schedule","130% of CMS OPPS rate",629.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1745.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1745.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1745.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1745.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",85.97,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2781,90,,,,,0,"percent of total billed charges","90% of total billed charges",1081.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2122.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.86,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1792.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",629.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.86,2781,
"BB FRESH FROZEN PLASMA UNIT",3109017,CDM,390,RC,P9017,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",109.57,130,,,,,0,"fee schedule","130% of CMS OPPS rate",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",85.97,102,,,,,0,"fee schedule","102% of CMS OPPS rate",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.86,90,,,,,0,"fee schedule","90% of CMS OPPS rate",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",84.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.86,508.5,
"BB PLATELET PHERESIS UNIT",3109034,CDM,390,RC,P9034,HCPCS,OUTPATIENT,,,2265,1812,,1925.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",516.26,130,,,,,0,"fee schedule","130% of CMS OPPS rate",461.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1279.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",405.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2038.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",792.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1556.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.41,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1313.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",461.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",397.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.41,2038.5,
"BB PLATELET UNIT",3109019,CDM,390,RC,P9019,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",98.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",77.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",68.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",75.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",68.36,391.5,
"RC ANTIBODY WORKUP",3186077,CDM,390,RC,86077,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.93,130,,,,,0,"fee schedule","130% of CMS OPPS rate",54.17,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.7,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",56.33,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",54.17,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,675,
"RC BLOOD L/R IRRADIATED",3109038,CDM,390,RC,P9040,HCPCS,OUTPATIENT,,,1215,972,,1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",332.54,130,,,,,0,"fee schedule","130% of CMS OPPS rate",247.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",686.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",260.91,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1093.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",425.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",834.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",230.22,90,,,,,0,"fee schedule","90% of CMS OPPS rate",704.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",247.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",255.8,100,,,,,0,"fee schedule","100% of CMS OPPS rate",230.22,1093.5,
"RC PRBC UNIT",3109021,CDM,390,RC,P9021,HCPCS,OUTPATIENT,,,1070,856,,909.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",187.61,130,,,,,0,"fee schedule","130% of CMS OPPS rate",217.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",147.19,102,,,,,0,"fee schedule","102% of CMS OPPS rate",963,90,,,,,0,"percent of total billed charges","90% of total billed charges",374.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",735.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.88,90,,,,,0,"fee schedule","90% of CMS OPPS rate",620.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",217.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",144.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.88,963,
"SB LEUKO-REDUC PRBC UNIT",3109040,CDM,390,RC,P9016,HCPCS,OUTPATIENT,,,1070,856,,909.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",182,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182,100,,,,,0,"fee schedule","100% of CMS OPPS rate",236.6,130,,,,,0,"fee schedule","130% of CMS OPPS rate",217.96,20.37,,174.30,174.30,174.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",604.55,56.5,,180.14,180.14,180.14,"1 through 10","percent of total billed charges","50.56% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",604.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",185.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",963,90,,,,,0,"percent of total billed charges","90% of total billed charges",374.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",735.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",182,100,,,,,0,"fee schedule","100% of CMS OPPS rate",163.8,90,,,,,0,"fee schedule","90% of CMS OPPS rate",620.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",217.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",182,100,,142.69,142.69,142.69,"1 through 10","fee schedule","100% of CMS OPPS rate",182,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",182,100,,,,,0,"fee schedule","100% of CMS OPPS rate",163.8,963,
"MM 3D MAMMO BIL DIAGNOSTIC",4300205,CDM,401,RC,G0279,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,19.09,19.09,19.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,40.26,19.50,40.26,15,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,18.79,18.79,18.79,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,10.53,10.53,10.53,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"MM 3D MAMMO UNILATERAL LEFT",4300207,CDM,401,RC,G0279,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,19.09,19.09,19.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,40.26,19.50,40.26,15,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,18.79,18.79,18.79,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,10.53,10.53,10.53,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"MM 3D MAMMO UNILATERAL RIGHT",4300208,CDM,401,RC,G0279,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,19.09,19.09,19.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,40.26,19.50,40.26,15,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,18.79,18.79,18.79,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,10.53,10.53,10.53,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"MM BREAST BX PERCUT NO IMAGI",4319100,CDM,401,RC,19100,HCPCS,OUTPATIENT,,,1465,1172,,1245.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",366.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",366.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",366.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",298.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",827.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",827.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",827.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",823.33,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",1318.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",512.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1006.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1318.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",849.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",298.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1245.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",298.42,1318.5,
"MM DIGITAL MAMMO DIAGNOSTIC W/CAD BIL",4300204,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,615,492,,522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",153.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",153.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",153.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",125.28,20.37,,97.02,97.02,97.02,"1 through 10","percent of total billed charges","20.37% of total billed charges",347.48,56.5,,42.72,35.01,225.81,19,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",345.63,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",553.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",215.25,35,,105.38,105.38,105.38,"1 through 10","percent of total billed charges","35% of total billed charges",422.51,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",553.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",356.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,59.02,59.02,59.02,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",125.28,553.5,
"MM DIGITAL MAMMO UNILATERAL  LEFT W/CAD",4300206,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,97.02,97.02,97.02,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,42.72,35.01,225.81,19,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,105.38,105.38,105.38,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,59.02,59.02,59.02,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"MM DIGITAL MAMMO UNILATERAL  RIGHT W/CAD",4302060,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,97.02,97.02,97.02,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,42.72,35.01,225.81,19,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,105.38,105.38,105.38,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,59.02,59.02,59.02,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"MM DIGITAL SPOT MAG  LEFT",4300002,CDM,401,RC,77066,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"MM DIGITAL SPOT MAG BILATERAL",4300004,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,97.02,97.02,97.02,"1 through 10","percent of total billed charges","20.37% of total billed charges",307.93,56.5,,42.72,35.01,225.81,19,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",306.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,105.38,105.38,105.38,"1 through 10","percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,59.02,59.02,59.02,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"MM DIGITAL SPOT MAG RIGHT",4300003,CDM,401,RC,77065,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,97.02,97.02,97.02,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,42.72,35.01,225.81,19,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,105.38,105.38,105.38,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,59.02,59.02,59.02,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
PERITONOCENTESIS,4649080,CDM,402,RC,49083,HCPCS,OUTPATIENT,,,3475,2780,,2953.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",707.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1952.95,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3127.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1216.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2387.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2015.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",707.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2953.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",707.86,3127.5,
"US 1ST TRIM FETAL NUC MEA EACH ADDITION",4676814,CDM,402,RC,76814,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",382.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,612,
"US 1ST TRIM FETAL NUC MEASURE ATTV",4676813,CDM,402,RC,76813,HCPCS,OUTPATIENT,,,1180,944,,1003,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",240.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",666.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",663.16,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1062,90,,,,,0,"percent of total billed charges","90% of total billed charges",413,35,,,,,0,"percent of total billed charges","35% of total billed charges",810.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",684.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",240.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1003,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,1062,
"US ABDOMEN COMPLETE",4676700,CDM,402,RC,76700,HCPCS,OUTPATIENT,,,1185,948,,1007.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",241.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",669.53,56.5,,39.25,20.36,390.74,"1 through 10","percent of total billed charges","50.56% of total billed charges",669.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",669.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",665.97,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1066.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",414.75,35,,189.19,189.19,189.19,"1 through 10","percent of total billed charges","35% of total billed charges",814.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",687.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",241.38,20.37,,101.26,33.32,169.20,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1007.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,1066.5,
"US ABDOMEN RUQ",4600004,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,292.27,24.58,598.21,25,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,41,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US ADDITIONAL CYST ASPIRATION",4619001,CDM,402,RC,19001,HCPCS,OUTPATIENT,,,540,432,,459,85,,,,,0,"percent of total billed charges","85% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",135,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",110,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",305.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",303.48,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",189,35,,,,,0,"percent of total billed charges","35% of total billed charges",370.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",110,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",459,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",110,486,
"US AMNIOCENTESIS GUIDANC",4676946,CDM,402,RC,76946,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",222.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",500.18,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",181.29,801,
"US AORTA",4676771,CDM,402,RC,76775,HCPCS,OUTPATIENT,,,1005,804,,854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",204.72,20.37,,163.71,163.71,163.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",567.83,56.5,,85.86,24.71,512.14,"1 through 10","percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",564.81,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",351.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",690.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",582.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",204.72,20.37,,127.05,100.32,153.77,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,66.67,75.76,18,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,904.5,
"US BLADDER",4676775,CDM,402,RC,76775,HCPCS,OUTPATIENT,,,1005,804,,854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",204.72,20.37,,163.71,163.71,163.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",567.83,56.5,,85.86,24.71,512.14,"1 through 10","percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",564.81,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",351.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",690.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",582.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",204.72,20.37,,127.05,100.32,153.77,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,66.67,75.76,18,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,904.5,
"US BREAST-LEFT",4600003,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",133.42,20.37,,67.21,38.31,96.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",370.08,56.5,,36.00,36.00,569.58,14,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,106.79,102.61,110.97,"1 through 10","percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,101.57,101.57,101.57,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,59.65,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,589.5,
"US BREAST-RIGHT",4676645,CDM,402,RC,76642,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",133.42,20.37,,67.21,38.31,96.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",370.08,56.5,,36.00,36.00,569.58,14,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",368.11,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,106.79,102.61,110.97,"1 through 10","percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,101.57,101.57,101.57,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,59.65,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72.01,589.5,
"US COMP PSEUDOANURYS GUI",4676936,CDM,402,RC,76936,HCPCS,OUTPATIENT,,,2810,2248,,2388.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",572.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1587.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1587.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1587.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1579.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2529,90,,,,,0,"percent of total billed charges","90% of total billed charges",983.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1930.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1629.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",572.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2388.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,2529,
"US CYST ASPIRATION",4619000,CDM,402,RC,19000,HCPCS,OUTPATIENT,,,1055,844,,896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",214.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",592.91,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",949.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",369.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",724.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",611.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",214.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,501.27,501.27,501.27,"1 through 10","fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",214.9,949.5,
"US CYST GUIDANCE NEEDLE",4676942,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,905,724,,769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,20.37,,117.68,117.68,117.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",508.61,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",621.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",524.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",184.35,20.37,,186.79,186.79,186.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,814.5,
"US DOPPLER VELOCIMETRY FETAL UMBILICAL",4676820,CDM,402,RC,76820,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,684,
"US ECHOENCEPHALOGRAPHY",4676506,CDM,402,RC,76506,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",441.17,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",274.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,706.5,
"US EXTREM NON-VASC LT",4600007,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",435.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,697.5,
"US EXTREM NON-VASC RT",4676880,CDM,402,RC,76882,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",435.55,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,697.5,
"US FETAL < 14 WKS",4676801,CDM,402,RC,76801,HCPCS,OUTPATIENT,,,1020,816,,867,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",207.77,20.37,,111.99,79.06,144.91,"1 through 10","percent of total billed charges","20.37% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",573.24,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",918,90,,,,,0,"percent of total billed charges","90% of total billed charges",357,35,,,,,0,"percent of total billed charges","35% of total billed charges",700.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",591.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",867,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,918,
"US FETAL < 14 WKS EACH ADDITIONAL",4676802,CDM,402,RC,76802,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"US FETAL >14 WKS COMPLETE",4676805,CDM,402,RC,76805,HCPCS,OUTPATIENT,,,1020,816,,867,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",207.77,20.37,,35.33,35.33,35.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",573.24,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",918,90,,,,,0,"percent of total billed charges","90% of total billed charges",357,35,,48.90,48.90,48.90,"1 through 10","percent of total billed charges","35% of total billed charges",700.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",591.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",867,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,918,
"US FETAL >14 WKS EACH ADDITIONAL FETUS",4676810,CDM,402,RC,76810,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",334.39,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"US FETAL BIOPHYSICAL & NONSTRESS",4676818,CDM,402,RC,76818,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,684,
"US FETAL BIOPHYSICAL W/O STRESS",4676819,CDM,402,RC,76819,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",427.12,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,684,
"US FETAL DETAILED FETAL ANATOMY",4676811,CDM,402,RC,76811,HCPCS,OUTPATIENT,,,1350,1080,,1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",275,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",758.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1215,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",927.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",783,58,,,,,0,"percent of total billed charges","58% of total billed charges",275,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1215,
"US FETAL GROWTH PARA IURG FOLLOW-UP",4676816,CDM,402,RC,76816,HCPCS,OUTPATIENT,,,1350,1080,,1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",275,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",758.7,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1215,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",927.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",783,58,,,,,0,"percent of total billed charges","58% of total billed charges",275,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,1215,
"US FETAL LTD",4676815,CDM,402,RC,76815,HCPCS,OUTPATIENT,,,870,696,,739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.94,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,35,,32.16,32.16,32.16,"1 through 10","percent of total billed charges","35% of total billed charges",597.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",504.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,783,
"US FETAL TRANSVAGINAL",4676817,CDM,402,RC,76817,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,387.73,387.73,387.73,"1 through 10","percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,108.23,108.23,108.23,"1 through 10","percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,630,
"US GUIDANCE INTRAOPERATIVE",4676986,CDM,402,RC,76998,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",270,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",220,972,
"US GUIDANCE INTRAOPERATIVE",4676998,CDM,402,RC,76998,HCPCS,OUTPATIENT,,,905,724,,769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",508.61,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",621.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",524.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,814.5,
"US GUIDANCE-NEEDLE BIOPS",4600008,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,1235,988,,1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",308.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.57,20.37,,117.68,117.68,117.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",694.07,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",848.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",716.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",251.57,20.37,,186.79,186.79,186.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",251.57,1111.5,
"US GUIDE THORA/PARACENTIS",4600010,CDM,402,RC,76942,HCPCS,OUTPATIENT,,,1170,936,,994.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",292.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",292.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",292.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.33,20.37,,117.68,117.68,117.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",661.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",661.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",661.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",657.54,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",1053,90,,,,,0,"percent of total billed charges","90% of total billed charges",409.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",803.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1053,90,,,,,0,"percent of total billed charges","90% of total billed charges",678.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",238.33,20.37,,186.79,186.79,186.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",994.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",238.33,1053,
"US GUIDE VASCULAR ACCESS",4676937,CDM,402,RC,76937,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,10.58,10.58,10.58,"1 through 10","percent of total billed charges","20.37% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.44,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"US KIDNEY",4676770,CDM,402,RC,76775,HCPCS,OUTPATIENT,,,1005,804,,854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",204.72,20.37,,163.71,163.71,163.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",567.83,56.5,,85.86,24.71,512.14,"1 through 10","percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",564.81,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",351.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",690.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",582.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",204.72,20.37,,127.05,100.32,153.77,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,66.67,75.76,18,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,904.5,
"US KIDNEY AND BLADDER",4686770,CDM,402,RC,76770,HCPCS,OUTPATIENT,,,1505,1204,,1279.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",306.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",850.33,56.5,,38.99,30.10,817.62,"1 through 10","percent of total billed charges","50.56% of total billed charges",850.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",850.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",845.81,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1354.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",526.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1033.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",872.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",306.57,20.37,,16.43,16.35,16.50,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,37.05,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1279.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,1354.5,
"US LIMITED",4676705,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,1045,836,,888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",212.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",590.43,56.5,,292.27,24.58,598.21,25,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",590.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",587.29,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",940.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",365.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",717.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",606.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",212.87,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,41,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",888.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,940.5,
"US LIVER",4600005,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,292.27,24.58,598.21,25,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,41,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US PANCREAS",4600006,CDM,402,RC,76705,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,292.27,24.58,598.21,25,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,41,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US PELVIC",4607685,CDM,402,RC,76856,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,172.93,172.93,172.93,"1 through 10","percent of total billed charges","20.37% of total billed charges",610.2,56.5,,60.54,27.76,446.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,172.43,172.43,172.43,"1 through 10","percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US PELVIC (NON-OB)",4676856,CDM,402,RC,76856,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,172.93,172.93,172.93,"1 through 10","percent of total billed charges","20.37% of total billed charges",610.2,56.5,,60.54,27.76,446.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",606.96,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,172.43,172.43,172.43,"1 through 10","percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US SCROTUM & CONTENTS",4676870,CDM,402,RC,76870,HCPCS,OUTPATIENT,,,870,696,,739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",177.22,20.37,,138.72,138.72,138.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",491.55,56.5,,373.47,130.54,452.98,"1 through 10","percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.94,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",597.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",504.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,783,
"US SOFT TISS MASS HEAD/NECK",4600002,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,73.78,30.57,116.98,"1 through 10","percent of total billed charges","20.37% of total billed charges",457.65,56.5,,26.61,18.35,448.66,14,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",455.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,122.24,122.24,122.24,"1 through 10","percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,15,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,729,
"US SOFT TISSUE NECK/HEAD",4676536,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,930,744,,790.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",189.44,20.37,,73.78,30.57,116.98,"1 through 10","percent of total billed charges","20.37% of total billed charges",525.45,56.5,,26.61,18.35,448.66,14,"percent of total billed charges","50.56% of total billed charges",525.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",525.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",522.66,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",837,90,,,,,0,"percent of total billed charges","90% of total billed charges",325.5,35,,122.24,122.24,122.24,"1 through 10","percent of total billed charges","35% of total billed charges",638.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",539.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",189.44,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,15,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",790.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,837,
"US THYROID",4600001,CDM,402,RC,76536,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,73.78,30.57,116.98,"1 through 10","percent of total billed charges","20.37% of total billed charges",457.65,56.5,,26.61,18.35,448.66,14,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",455.22,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,122.24,122.24,122.24,"1 through 10","percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,16.33,16.33,16.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,15,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,729,
"US TRANSPLANT KIDNEY",4676776,CDM,402,RC,76776,HCPCS,OUTPATIENT,,,795,636,,675.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",161.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",449.18,56.5,,305.24,305.24,305.24,"1 through 10","percent of total billed charges","50.56% of total billed charges",449.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",449.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",446.79,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",715.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",278.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",546.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",461.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",161.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",675.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,715.5,
"US TRANSVAGINAL (NON-OB)",4676830,CDM,402,RC,76830,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",142.59,20.37,,114.03,114.03,114.03,"1 through 10","percent of total billed charges","20.37% of total billed charges",395.5,56.5,,188.75,188.75,188.75,"1 through 10","percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",393.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,630,
"MM 3D MAMMO BIL SCREENING",4300203,CDM,403,RC,77063,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,23.47,19.97,26.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,76.79,30.15,77.55,73,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",78.68,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,25.57,22.99,28.14,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,19.35,19.35,21.15,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,20.15,20.15,20.15,197,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"MM DIGITAL MAMMO SCREENING W/CAD BIL",4300202,CDM,403,RC,77067,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,70.99,41.87,74.55,"1 through 10","percent of total billed charges","20.37% of total billed charges",254.25,56.5,,237.57,40.11,237.57,73,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",252.9,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,91.36,75.75,106.97,"1 through 10","percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,71.85,71.85,71.85,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,77.61,77.61,77.61,201,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"MM MAMMOGRAM/BIOPSY",4376096,CDM,409,RC,,,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",171.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",139.53,616.5,
"MM MAMMOGRAM/TISSUE",4376098,CDM,409,RC,76098,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",647.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",112.4,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",508.22,102,,,,,0,"fee schedule","102% of CMS OPPS rate",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",448.43,90,,,,,0,"fee schedule","90% of CMS OPPS rate",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",498.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",40.74,647.74,
"ARTERIAL PUNCTURE",5536600,CDM,410,RC,36600,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",21.39,20.37,,13.20,13.20,13.20,"1 through 10","percent of total billed charges","20.37% of total billed charges",59.33,56.5,,1359.51,906.03,1987.06,"1 through 10","percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,16.76,16.76,16.76,"1 through 10","percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,16.76,16.76,16.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",21.39,152.27,
"BIPAP INITIAL",5594656,CDM,410,RC,94002,HCPCS,OUTPATIENT,,,1275,1020,,1083.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",780.99,130,,,,,0,"fee schedule","130% of CMS OPPS rate",259.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",612.78,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1147.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",446.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",875.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",540.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",739.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",259.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",600.76,100,,471.01,471.01,471.01,"1 through 10","fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1083.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",259.72,1147.5,
"BIPAP SUBSEQUENT",5594657,CDM,410,RC,94003,HCPCS,OUTPATIENT,,,1290,1032,,1096.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",780.99,130,,,,,0,"fee schedule","130% of CMS OPPS rate",262.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",728.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",728.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",728.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",728.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",612.78,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1161,90,,,,,0,"percent of total billed charges","90% of total billed charges",451.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",886.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",540.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",748.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",262.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1096.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",262.77,1161,
"CONTINUOUS INHALATION EACH ADD HR",5594645,CDM,410,RC,94645,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"CONTINUOUS INHALATION TX 1ST HR",550005,CDM,410,RC,94644,HCPCS,OUTPATIENT,,,405,324,,344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",141.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",278.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",234.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",82.5,364.5,
"CP OTH RESP PROC GROUP",5800239,CDM,410,RC,G0239,HCPCS,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.36,130,,,,,0,"fee schedule","130% of CMS OPPS rate",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",36.36,102,,,,,0,"fee schedule","102% of CMS OPPS rate",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",32.09,90,,,,,0,"fee schedule","90% of CMS OPPS rate",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",35.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",29.54,130.5,
"CPT (CHEST PHYSIO THER INITIAL)",5594667,CDM,410,RC,94667,HCPCS,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",26.48,20.37,,20.51,20.51,20.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",26.48,152.27,
"CPT (CHEST PHYSIO THER SUBSEQU)",5594668,CDM,410,RC,94668,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",23.43,152.27,
"EVALUATE PT USE OF INHALER",5594665,CDM,410,RC,94664,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.37,240.27,
"INCENTIVE SPIROMETER TX",5500002,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",136.48,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",136.48,603,
"INITIAL NEB TX",5500006,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",136.48,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",136.48,603,
INTUBATION,5531500,CDM,410,RC,31500,HCPCS,OUTPATIENT,,,1055,844,,896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",214.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",596.08,56.5,,1545.78,1337.27,1754.29,"1 through 10","percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",949.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",369.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",724.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",611.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",214.9,20.37,,168.44,168.44,168.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",211.02,100,,165.44,165.44,165.44,"1 through 10","fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,949.5,
"NASO TRACHEAL SUCTION",5531720,CDM,410,RC,31720,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",18.33,20.37,,13.52,13.52,13.52,"1 through 10","percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",18.33,240.27,
"NEWBORN RESUSCITATION",502101,CDM,410,RC,99465,HCPCS,OUTPATIENT,,,590,472,,501.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",773.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",120.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",333.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",606.54,102,,,,,0,"fee schedule","102% of CMS OPPS rate",531,90,,,,,0,"percent of total billed charges","90% of total billed charges",206.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",405.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",535.19,90,,,,,0,"fee schedule","90% of CMS OPPS rate",342.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",120.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",501.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",120.18,773.05,
"SPUTUM COLLECTION",5594664,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",9.17,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.17,240.27,
"SPUTUM INDUCTION",5500015,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",20.37,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.37,240.27,
"SUB NEB TX",5500005,CDM,410,RC,94640,HCPCS,OUTPATIENT,,,415,332,,352.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",84.54,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",373.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",145.25,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",285.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",240.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",84.54,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",352.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.54,373.5,
"VENT MGMT INPAT SUBQ DAY",5594003,CDM,410,RC,94003,HCPCS,OUTPATIENT,,,1275,1020,,1083.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",780.99,130,,,,,0,"fee schedule","130% of CMS OPPS rate",259.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",612.78,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1147.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",446.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",875.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",540.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",739.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",259.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1083.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",259.72,1147.5,
"VENTILATOR INITIAL",5594002,CDM,410,RC,94002,HCPCS,OUTPATIENT,,,1275,1020,,1083.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",780.99,130,,,,,0,"fee schedule","130% of CMS OPPS rate",259.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",720.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",612.78,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1147.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",446.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",875.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",540.69,90,,,,,0,"fee schedule","90% of CMS OPPS rate",739.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",259.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",600.76,100,,471.01,471.01,471.01,"1 through 10","fee schedule","100% of CMS OPPS rate",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1083.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",600.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",259.72,1147.5,
"PT AQUATIC THERAPY (PER 15 MIN)",5007113,CDM,420,RC,97113,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,166.18,73.53,207.71,"1 through 10","percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,269.60,269.60,269.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,56.87,56.87,56.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,66.03,56.85,72.81,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"PT AQUATIC THERAPY (PER 15 MIN)",5097113,CDM,420,RC,97113,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,166.18,73.53,207.71,"1 through 10","percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,269.60,269.60,269.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,56.87,56.87,56.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,66.03,56.85,72.81,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"PT ATTEN ELECT STIM (PER 15 MINS)",5007032,CDM,420,RC,97032,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,10.91,9.85,77.51,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT ATTEN ELECT STIM (PER 15 MINS)",5097032,CDM,420,RC,97032,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,10.91,9.85,77.51,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT BAL & COORDIN ACT (PER 15 MINS)",5000112,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.08,36.05,84.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,36.79,175.15,34,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,124.69,204.97,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,18.34,15.58,35.74,36,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT CANALITH REPOSITIONING PROCEDURE",5095992,CDM,420,RC,95992,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,108.57,46.63,130.28,"1 through 10","percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,50.00,50.00,50.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,30.85,30.85,30.85,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"PT CAREGIVER TRAING 1ST 30 MIN",5097550,CDM,420,RC,97550,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,39.20,39.20,39.20,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"PT CAREGIVER TRAING 1ST 30 MIN",5098550,CDM,420,RC,97550,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,39.20,39.20,39.20,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"PT CAREGIVER TRAING ADDL 15",5097551,CDM,420,RC,97551,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"PT CAREGIVER TRAING ADDL 15",5098551,CDM,420,RC,97551,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"PT CONTRAST BATH (PER 15 MINS)",5097034,CDM,420,RC,97034,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT GAIT TRA (PER 15 MINS)",5007116,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,31.01,29.55,54.26,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,49.52,204.94,14,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,104.74,124.69,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,29.54,29.54,29.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,16.51,14.03,22.00,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT GAIT TRA (PER 15 MINS)",5097116,CDM,420,RC,97116,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,31.01,29.55,54.26,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,49.52,204.94,14,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,104.74,124.69,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,29.54,29.54,29.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,16.51,14.03,22.00,30,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT GROSS MOTOR DEVE SEQ(PER 15 MINS)",5009711,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.08,36.05,84.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,36.79,175.15,34,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,124.69,204.97,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,18.34,15.58,35.74,36,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT GROUP THER PROC (PER SESSION)",5097150,CDM,420,RC,97150,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT IONTOPHORESIS (PER 15 MINS)",5007033,CDM,420,RC,97033,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT IONTOPHORESIS (PER 15 MINS)",5097033,CDM,420,RC,97033,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT MANUAL THERAPY (PER 15 MINS)",5007140,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,45.11,33.13,57.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,18.36,102.47,35,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,28.61,28.61,28.61,"1 through 10","percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,84.71,124.69,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,13.32,13.32,25.89,41,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT MANUAL THERAPY (PER 15 MINS)",5097140,CDM,420,RC,97140,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,45.11,33.13,57.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,18.36,102.47,35,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,28.61,28.61,28.61,"1 through 10","percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,84.71,124.69,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,13.32,13.32,25.89,41,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT MECHAN MODALITY (PER 15 MINS)",5097039,CDM,420,RC,97039,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT MOD-MASSAGE (PER 15 MINS)",5097154,CDM,420,RC,97124,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"PT MOD-PARAFFIN BATH (PER SESSION)",5097018,CDM,420,RC,97018,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"PT MOD-ULTRASOUND (PER 15 MINS)",5007035,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,17.11,17.11,17.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",59.33,56.5,,58.16,27.46,58.16,16,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,70.77,70.77,70.77,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,7.97,7.97,7.97,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"PT MOD-ULTRASOUND (PER 15 MINS)",5097035,CDM,420,RC,97035,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,17.11,17.11,17.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",59.33,56.5,,58.16,27.46,58.16,16,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,70.77,70.77,70.77,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,7.97,7.97,7.97,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"PT MOD-VASOPNEUMATIC DEV (PER SESSION)",5097016,CDM,420,RC,97016,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT NEURO RE-EDUCATION",5007112,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.08,36.05,84.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,36.79,175.15,34,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,124.69,204.97,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,18.34,15.58,35.74,36,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT NEURO RE-EDUCATION (PER 15 MINS)",5097112,CDM,420,RC,97112,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.08,36.05,84.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,36.79,175.15,34,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,124.69,204.97,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,18.34,15.58,35.74,36,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT ORTHOTIC TRAINING (PER SESSION)",5097760,CDM,420,RC,97760,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"PT PATIENT EDUCATION (PER 15 MINS)",5097535,CDM,420,RC,97535,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"PT PHY PERFM TEST (PER 15 MINS)",5097750,CDM,420,RC,97750,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT PROST/ORTHOT CK (PER 15 MINS)",5097762,CDM,420,RC,97762,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT PROSTHETIC TRAINING(PER 15 MINS)",5007761,CDM,420,RC,97761,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"PT PROSTHETIC TRAINING(PER 15 MINS)",5097761,CDM,420,RC,97761,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"PT ROM EXTREMITY NOT HAND",5095851,CDM,420,RC,95851,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT SENSORY INTEGRAT(PER 15 MINS)",5097533,CDM,420,RC,97533,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"PT TENS FITTING APPLIC (PER SESSION)",5064550,CDM,420,RC,64550,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT THER EXERC (PER 15 MINS)",5007110,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.07,57.83,61.64,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,157.29,76.97,270.36,46,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,85.81,85.81,85.81,"1 through 10","percent of total billed charges","35% of total billed charges",127.1,68.7,,187.04,55.42,249.38,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,70.84,21.61,87.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,16.51,14.03,37.84,63,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT THER EXERC (PER 15 MINS)",5097110,CDM,420,RC,97110,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.07,57.83,61.64,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,157.29,76.97,270.36,46,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,85.81,85.81,85.81,"1 through 10","percent of total billed charges","35% of total billed charges",127.1,68.7,,187.04,55.42,249.38,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,70.84,21.61,87.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,16.51,14.03,37.84,63,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT THERAPEUTIC ACT (PER 15 MINS)",5097530,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,62.16,38.41,64.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",113,56.5,,110.78,60.38,208.27,35,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,134.80,56.51,134.80,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,25.32,18.38,37.15,58,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"PT THERAPEUTIC ACT (PER 15 MINS)",5597530,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,62.16,38.41,64.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",113,56.5,,110.78,60.38,208.27,35,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,134.80,56.51,134.80,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,25.32,18.38,37.15,58,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"PT TRACTION MECHANICAL(PER SESSION)",5007012,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT TRACTION MECHANICAL(PER SESSION)",5097012,CDM,420,RC,97012,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT ULTRAVIOLET (PER SESSION)",5097026,CDM,420,RC,97026,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"PT UNATTEN ELECT STIMULA(PER SESSION)",5007014,CDM,420,RC,97014,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,27.69,27.69,27.69,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,93.25,74.60,94.16,22,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,26.28,26.28,26.28,"1 through 10","percent of total billed charges","35% of total billed charges",116.79,68.7,,114.58,114.58,114.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT UNATTEN ELECT STIMULA(PER SESSION)",5010283,CDM,420,RC,G0283,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,27.59,27.59,27.59,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,94.16,19.38,94.16,23,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,103.12,28.49,114.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,6.46,5.93,6.98,42,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT UNATTEN ELECT STIMULA(PER SESSION)",5097014,CDM,420,RC,97014,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,27.69,27.69,27.69,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,93.25,74.60,94.16,22,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,26.28,26.28,26.28,"1 through 10","percent of total billed charges","35% of total billed charges",116.79,68.7,,114.58,114.58,114.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT UNNA BOOT APPLICATION (PER SESSION)",5029580,CDM,420,RC,29580,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"PT VESTIBULAR ACT (PER 15 MINS)",5000003,CDM,420,RC,97530,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,62.16,38.41,64.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",113,56.5,,110.78,60.38,208.27,35,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,134.80,56.51,134.80,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,25.32,18.38,37.15,58,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"PT WHEELCHAIR MNGT TRAINI (PER 15 MINS)",5097542,CDM,420,RC,97542,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"PT WHIRLPOOL (PER SESSION)",5097022,CDM,420,RC,97022,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"PT WORK HARDENING 1 2HR",5097545,CDM,420,RC,97545,HCPCS,OUTPATIENT,,,415,332,,352.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",103.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",103.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",103.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",84.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",234.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",373.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",145.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",285.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",373.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",240.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",84.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",352.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",84.54,373.5,
"PT WORK HARDENING ADDON",5097546,CDM,420,RC,97546,HCPCS,OUTPATIENT,,,210,168,,178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",52.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",118.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",73.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",144.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",189,90,,,,,0,"percent of total billed charges","90% of total billed charges",121.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",42.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",178.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",42.78,189,
"PT WOUND CARE NON SELECTI (PER SESSION)",5099211,CDM,420,RC,99211,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",197.75,56.5,,181.68,181.68,181.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"PT WOUND CARE SEL GR 20SQCM (PER SESSION",5097598,CDM,420,RC,97598,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,463.5,
"PT WOUND CARE SEL LS 20SQCM (PER SESSION",5097597,CDM,420,RC,97597,HCPCS,OUTPATIENT,,,605,484,,514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",544.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",415.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",350.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",123.24,544.5,
"PT EVAL HIGH COMPLEXITY",5097163,CDM,424,RC,97163,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,91.74,40.50,186.49,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,60.39,60.39,60.39,"1 through 10","percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,72.66,72.66,72.66,20,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"PT EVAL LOW COMPLEXITY",5097161,CDM,424,RC,97161,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,66.79,66.61,68.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,193.04,88.08,227.10,31,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,63.39,63.39,63.39,"1 through 10","percent of total billed charges","35% of total billed charges",281.67,68.7,,276.34,243.18,276.34,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,62.46,62.46,62.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,72.66,72.66,72.66,50,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"PT EVAL MODERATE COMPLEXITY",5097162,CDM,424,RC,97162,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,66.27,64.29,68.25,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,226.00,80.17,227.10,18,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,63.39,63.39,63.39,"1 through 10","percent of total billed charges","35% of total billed charges",281.67,68.7,,276.34,276.34,276.34,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,72.66,72.66,72.66,48,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"PT RE EVALUATION (PER SESSION)",5097164,CDM,424,RC,97164,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,149.55,149.55,149.55,"1 through 10","percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,49.76,49.76,49.76,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"PT REGULAR VISIT",5000001,CDM,424,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"PT STUDENT-TEACHER CONFERENCE",5000002,CDM,424,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"OT ADT TRAINING (PER 15 MINS)",5129132,CDM,430,RC,97535,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OT APPLICAT FINGER SPLT D (PER SESSION)",5129131,CDM,430,RC,29131,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT APPLICAT FINGER SPLT S (PER SESSION)",5129130,CDM,430,RC,29130,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,35.30,23.16,47.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,1004.68,778.99,1230.37,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,49.47,49.47,49.47,"1 through 10","percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT APPLICAT S ARM SPLT DY(PER SESSION)",5179126,CDM,430,RC,29126,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT APPLICATION ARM SPLINT(PER SESSION)",5129125,CDM,430,RC,29125,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,722.57,722.57,722.57,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT AQUATIC EXERCISE THERA(PER 15 MINS)",5197113,CDM,430,RC,97113,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,166.18,73.53,207.71,"1 through 10","percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,269.60,269.60,269.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,56.87,56.87,56.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,66.03,56.85,72.81,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"OT ATTENDED ELECT STIM (PER 15 MINS)",5197032,CDM,430,RC,97032,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,10.91,9.85,77.51,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT COGNITIVE SKILLS DEVEL(PER 15 MINS)",5197532,CDM,430,RC,97532,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT COMMUNITY WORK REENTRY (PER 15 MINS)",5197537,CDM,430,RC,97537,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"OT CONTRAST BATH (PER 15 MINS)",5197034,CDM,430,RC,97034,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT GROUP THERAPEUTIC PROC (PER SESSION)",5197150,CDM,430,RC,97150,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT IONTOPHORESIS (PER 15 MINS)",5197033,CDM,430,RC,97033,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT MANUAL THERAPY (PER 15 MINS)",5197140,CDM,430,RC,97140,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,45.11,33.13,57.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,18.36,102.47,35,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,28.61,28.61,28.61,"1 through 10","percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,84.71,124.69,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,13.32,13.32,25.89,41,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OT MASSAGE (PER 15 MINS)",5197124,CDM,430,RC,97124,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"OT MOD JOBST (PER SESSION)",5197016,CDM,430,RC,97016,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"OT NERVE & MUSCLE TESTING (PER 15 MINS)",5197750,CDM,430,RC,97750,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT NEUROMUSCU REEDUCATION (PER 15 MINS)",5197112,CDM,430,RC,97112,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.08,36.05,84.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,102.47,36.79,175.15,34,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,124.69,124.69,204.97,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,28.04,26.84,29.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,18.34,15.58,35.74,36,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OT ORTHOTIC TRAIN/FAB (PER 15 MINS)",5197760,CDM,430,RC,97760,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"OT PARAFFIN BATH (PER SESSION)",5197018,CDM,430,RC,97018,HCPCS,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"OT PROSTHETIC TRAIN/FAB (PER 15 MINS)",5197761,CDM,430,RC,97761,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT REGULAR VISIT",5100001,CDM,430,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"OT SELF CARE MNGT TRAININ (PER 15 MINS)",5197535,CDM,430,RC,97535,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT SENSORY INTEGRAT (PER 15 MINS)",5197533,CDM,430,RC,97533,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"OT STRAPPING ELBOW OR WRI (PER SESSION)",5129260,CDM,430,RC,29260,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,41.54,41.54,41.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,1806.42,1806.42,1806.42,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT STRAPPING HAND OR FING (PER SESSION)",5129280,CDM,430,RC,29280,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,41.54,41.54,41.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT STRAPPING OF LOW BACK (PER SESSION)",5129220,CDM,430,RC,29799,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,186.4,
"OT STRAPPING OF SHOULDER (PER SESSION)",5129240,CDM,430,RC,29240,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,722.57,722.57,722.57,"1 through 10","percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,153,
"OT STRAPPING OF THORAX (PER SESSION)",5129200,CDM,430,RC,29200,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,186.4,
"OT THERAPEUTIC ACT (PER 15 MINS)",5197530,CDM,430,RC,97530,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,62.16,38.41,64.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,110.78,60.38,208.27,35,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,134.80,56.51,134.80,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,25.32,18.38,37.15,58,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OT THERAPEUTIC EX (PER 15 MINS)",5197110,CDM,430,RC,97110,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,60.07,57.83,61.64,"1 through 10","percent of total billed charges","20.37% of total billed charges",104.53,56.5,,157.29,76.97,270.36,46,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,85.81,85.81,85.81,"1 through 10","percent of total billed charges","35% of total billed charges",127.1,68.7,,187.04,55.42,249.38,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,70.84,21.61,87.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,16.51,14.03,37.84,63,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OT ULTRASOUND (PER 15 MINS)",5197035,CDM,430,RC,97035,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,17.11,17.11,17.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",59.33,56.5,,58.16,27.46,58.16,16,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,70.77,70.77,70.77,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,7.97,7.97,7.97,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"OT UNATTEND ELECT STIM (PER SESSION)",5197014,CDM,430,RC,97014,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,27.69,27.69,27.69,"1 through 10","percent of total billed charges","20.37% of total billed charges",56.5,56.5,,93.25,74.60,94.16,22,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,26.28,26.28,26.28,"1 through 10","percent of total billed charges","35% of total billed charges",68.7,68.7,,114.58,114.58,114.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"OT WHEELCHAIR MNGT TRAING (PER 15 MINS)",5197542,CDM,430,RC,97542,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"OT WHIRLPOOL (PER SESSION)",5197022,CDM,430,RC,97022,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"OT WOUND CARE NON SELECTI (PER SESSION)",5199211,CDM,430,RC,99211,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",197.75,56.5,,181.68,181.68,181.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"OT WOUND CARE SEL <20SQCM (PER SESSION)",5197598,CDM,430,RC,97598,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,463.5,
"OT WOUND CARE SEL >20SQCM (PER SESSION)",5197597,CDM,430,RC,97597,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",55,243,
"OT DEVELOPMENT EVAL  (PER SESSION)",5196110,CDM,434,RC,96110,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,274.5,
"OT EVALUATION (PER SESSION)",5197003,CDM,434,RC,97003,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"OT RE EVALUATION (PER SESSION)",5197004,CDM,434,RC,97004,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"ST APHASIA EVALUATION (PER 1 HOUR)",5296105,CDM,440,RC,96105,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,391.5,
"ST MODIFIED BARIUM SWALLOW (PER SESSION)",5292611,CDM,440,RC,92611,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"ST SPEECH SOUND LANG COMPREHEN",5292523,CDM,440,RC,92523,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",181.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",181.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",181.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",147.68,652.5,
"ST SPEECH THERAPY (PER SESSION)",5292507,CDM,440,RC,92507,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"ST SPEECH THRPY EVALUAT(PER SESSION)",5292506,CDM,440,RC,92506,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"ST SWALLOWING (PER SESSION)",5292526,CDM,440,RC,92526,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,391.5,
"ST SWALLOWING EVALUATION (PER SESSION)",5292610,CDM,444,RC,92610,HCPCS,OUTPATIENT,,,595,476,,505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",148.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",336.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",408.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",535.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",345.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",121.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",505.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",121.2,535.5,
"CASIRIVI AND IMDEV INFUSION",2610244,CDM,450,RC,,,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",400,25,,,,,0,"percent of total billed charges","25% of total billed charges",400,25,,,,,0,"percent of total billed charges","25% of total billed charges",400,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",325.92,1440,
"SOTROVIMAB INFUSION ER",2610248,CDM,450,RC,M0247,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",532.2,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",417.57,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",368.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",325.92,1440,
"ABD PARACENTESIS",2049082,CDM,450,RC,49082,HCPCS,OUTPATIENT,,,3200,2560,,2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2880,90,,,,,0,"percent of total billed charges","90% of total billed charges",1120,35,,,,,0,"percent of total billed charges","35% of total billed charges",2198.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1856,58,,,,,0,"percent of total billed charges","58% of total billed charges",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",651.84,2880,
"ABD PARACENTESIS W/IMAGING",2049083,CDM,450,RC,49083,HCPCS,OUTPATIENT,,,3200,2560,,2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2880,90,,,,,0,"percent of total billed charges","90% of total billed charges",1120,35,,,,,0,"percent of total billed charges","35% of total billed charges",2198.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1856,58,,,,,0,"percent of total billed charges","58% of total billed charges",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",651.84,2880,
"ANOSCOPY REMOVE FOR BODY",2046608,CDM,450,RC,46608,HCPCS,OUTPATIENT,,,3200,2560,,2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2880,90,,,,,0,"percent of total billed charges","90% of total billed charges",1120,35,,,,,0,"percent of total billed charges","35% of total billed charges",2198.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1856,58,,,,,0,"percent of total billed charges","58% of total billed charges",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",651.84,2880,
"APPLICATION OF PASTE BOOT",2029580,CDM,450,RC,29580,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"APPLY GAUNTLET CAST",2029085,CDM,450,RC,29085,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,697.5,
"ASPIRATE PLEURA W/ IMAGING",2032555,CDM,450,RC,32555,HCPCS,OUTPATIENT,,,1800,1440,,1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",730.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",573.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1620,90,,,,,0,"percent of total billed charges","90% of total billed charges",630,35,,,,,0,"percent of total billed charges","35% of total billed charges",1236.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1044,58,,,,,0,"percent of total billed charges","58% of total billed charges",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",366.66,1620,
"ASPIRATE PLEURA W/O IMAGING",2032554,CDM,450,RC,32554,HCPCS,OUTPATIENT,,,1800,1440,,1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",730.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",573.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1620,90,,,,,0,"percent of total billed charges","90% of total billed charges",630,35,,,,,0,"percent of total billed charges","35% of total billed charges",1236.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1044,58,,,,,0,"percent of total billed charges","58% of total billed charges",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",366.66,1620,
ASPIRATION,2010160,CDM,450,RC,10160,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.91,471.98,
"ASPIRATION MJR JNT/BURSA",2020610,CDM,450,RC,20610,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,210.31,210.31,210.31,"1 through 10","fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165,729,
"ASPIRATION/INJ SML JOINT",2020600,CDM,450,RC,20600,HCPCS,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,,,,0,"percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",130.37,576,
"ASPIRATION/OR INJECTION  INTERMED JNT",2020605,CDM,450,RC,20605,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",147.68,652.5,
"BL DRAW < 3 YRS FEM/JUGULAR",2036400,CDM,450,RC,36400,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",231.2,1021.5,
"BL DRAW < 3 YRS OTHER VEIN",2036406,CDM,450,RC,36406,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",231.2,1021.5,
"BL DRAW < 3 YRS SCALP VEIN",2036405,CDM,450,RC,36405,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",283.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",231.2,1021.5,
"BLADDER IRRIG SIMPLE",2051700,CDM,450,RC,51700,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"BLEPHAROTOMY DRAIN ABSC EYELID",2067700,CDM,450,RC,67700,HCPCS,OUTPATIENT,,,1075,860,,913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",353.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",277.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",376.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",738.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.47,90,,,,,0,"fee schedule","90% of CMS OPPS rate",623.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",218.98,967.5,
"BURN DRESSING APPLICATION",2016020,CDM,450,RC,16020,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.57,20.37,,69.23,69.23,69.23,"1 through 10","percent of total billed charges","20.37% of total billed charges",240.13,56.5,,629.58,141.45,1117.70,"1 through 10","percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.57,382.5,
"BURN LARGE >1 EXTREMETY",2016030,CDM,450,RC,16030,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",111.02,490.5,
"BURN MED FACE/1 EXTREM",2016025,CDM,450,RC,16025,HCPCS,OUTPATIENT,,,505,404,,429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",454.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",292.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,141.57,141.57,141.57,"1 through 10","fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102.87,454.5,
"BURN SMALL DSG/DEBRIDMENT",2016021,CDM,450,RC,16020,HCPCS,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",96.76,20.37,,69.23,69.23,69.23,"1 through 10","percent of total billed charges","20.37% of total billed charges",268.38,56.5,,629.58,141.45,1117.70,"1 through 10","percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.76,427.5,
"BURNS 1 DEGREE LOCAL TX",2016000,CDM,450,RC,16000,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"BURNS W/DEBRIDMENT",2016010,CDM,450,RC,,,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"C REP TRUNK 2.6-7.5 CM",2013101,CDM,450,RC,13101,HCPCS,OUTPATIENT,,,1850,1480,,1572.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",376.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1045.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1045.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1045.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1045.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1665,90,,,,,0,"percent of total billed charges","90% of total billed charges",647.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1270.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1073,58,,,,,0,"percent of total billed charges","58% of total billed charges",376.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,436.12,436.12,436.12,"1 through 10","fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1572.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",376.85,1665,
"C REP TRUNK EA ADTL 5CM",2013102,CDM,450,RC,13102,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,391.5,
"CANALITH REPOSITIONING PROC",2095992,CDM,450,RC,95992,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,108.57,46.63,130.28,"1 through 10","percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,50.00,50.00,50.00,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,30.85,30.85,30.85,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
CARDIOVERSION,1092960,CDM,450,RC,92960,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",773.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,641.08,641.08,641.08,"1 through 10","percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",606.54,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",535.19,90,,,,,0,"fee schedule","90% of CMS OPPS rate",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",231.2,1021.5,
"CARDIOVERSION ER",2092960,CDM,450,RC,92960,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",773.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,641.08,641.08,641.08,"1 through 10","percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",606.54,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",535.19,90,,,,,0,"fee schedule","90% of CMS OPPS rate",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",231.2,1021.5,
"CAST LONG ARM QK C",2029065,CDM,450,RC,29065,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,,,,0,"percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.07,504,
"CAST LONG LEG QK C",2029345,CDM,450,RC,29345,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",181.29,801,
"CAST REMOVAL",2029705,CDM,450,RC,29705,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.17,313.74,
"CAST SHORT ARM QK C",2029075,CDM,450,RC,29075,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"CAST SHORT LEG QK C",2029405,CDM,450,RC,29405,HCPCS,OUTPATIENT,,,560,448,,476,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",316.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",504,90,,,,,0,"percent of total billed charges","90% of total billed charges",196,35,,,,,0,"percent of total billed charges","35% of total billed charges",384.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",324.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",114.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",476,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.07,504,
"CASTING STRAPPING PROCEDU",2029799,CDM,450,RC,29799,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"CENTRAL LINE PLACEMENT",2036556,CDM,450,RC,36556,HCPCS,OUTPATIENT,,,2030,1624,,1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",507.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",507.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",507.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",413.51,20.37,,78.83,78.83,78.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",1146.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1146.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1146.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1146.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",710.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1394.61,68.7,,5294.72,5294.72,5294.72,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",1177.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",413.51,20.37,,324.09,324.09,324.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,2242.45,2242.45,2242.45,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",413.51,1827,
"CHANGE OF BLADDER TUBE",2051710,CDM,450,RC,51710,HCPCS,OUTPATIENT,,,2400,1920,,2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",600,25,,,,,0,"percent of total billed charges","25% of total billed charges",600,25,,,,,0,"percent of total billed charges","25% of total billed charges",600,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2160,90,,,,,0,"percent of total billed charges","90% of total billed charges",840,35,,,,,0,"percent of total billed charges","35% of total billed charges",1648.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2160,90,,,,,0,"percent of total billed charges","90% of total billed charges",1392,58,,,,,0,"percent of total billed charges","58% of total billed charges",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",488.88,2160,
"CHEM CAUT OF GRANLTJ TISSUE",2017250,CDM,450,RC,17250,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,675,
"CHEST TUBE INSERTION",2032000,CDM,450,RC,,,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",228.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",228.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",228.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",186.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",186.39,823.5,
"CL TREATMENT ARTICULAR FRACTURE",2026742,CDM,450,RC,26742,HCPCS,OUTPATIENT,,,5970,4776,,5074.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1492.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1492.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1492.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1216.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5373,90,,,,,0,"percent of total billed charges","90% of total billed charges",2089.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4101.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5373,90,,,,,0,"percent of total billed charges","90% of total billed charges",3462.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1216.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5074.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1216.09,5373,
"CL TX FEMUR FX OR EPIPHYS SEP",2027510,CDM,450,RC,27510,HCPCS,OUTPATIENT,,,3910,3128,,3323.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",977.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",977.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",977.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",796.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3519,90,,,,,0,"percent of total billed charges","90% of total billed charges",1368.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2686.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3519,90,,,,,0,"percent of total billed charges","90% of total billed charges",2267.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",796.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3323.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",796.47,3519,
"CL TX IP JT WITH MANIPULATION",2026775,CDM,450,RC,26775,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,697.5,
"CL TX MC FX SGL MANIP EA BONE",2026600,CDM,450,RC,26600,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",457.65,56.5,,1606.42,1606.42,1606.42,"1 through 10","percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165,729,
"CL TX NASAL SEPTAL FX",2021337,CDM,450,RC,21337,HCPCS,OUTPATIENT,,,5540,4432,,4709,85,,,,,0,"percent of total billed charges","85% of total billed charges",1385,25,,,,,0,"percent of total billed charges","25% of total billed charges",1385,25,,,,,0,"percent of total billed charges","25% of total billed charges",1385,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1128.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4986,90,,,,,0,"percent of total billed charges","90% of total billed charges",1939,35,,,,,0,"percent of total billed charges","35% of total billed charges",3805.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4986,90,,,,,0,"percent of total billed charges","90% of total billed charges",3213.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1128.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4709,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1128.5,4986,
"CL TX POST HIP DL WO ANESTHESIA",2027265,CDM,450,RC,27265,HCPCS,OUTPATIENT,,,1075,860,,913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",376.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",738.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",623.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,967.5,
"CL TX TRIMALL ANKLE FX W MANIP",2027818,CDM,450,RC,27818,HCPCS,OUTPATIENT,,,3075,2460,,2613.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",768.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",768.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",768.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",626.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1737.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1737.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1737.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1737.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2767.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1076.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2112.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2767.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1783.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",626.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2613.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",626.38,2767.5,
"CL TX ULNAR SHFT W/ MANIPULATION",2025535,CDM,450,RC,25535,HCPCS,OUTPATIENT,,,1020,816,,867,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",918,90,,,,,0,"percent of total billed charges","90% of total billed charges",357,35,,,,,0,"percent of total billed charges","35% of total billed charges",700.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",591.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",867,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,918,
"CL TX WB DSTL TIB FX W MANIP",2027825,CDM,450,RC,27825,HCPCS,OUTPATIENT,,,4060,3248,,3451,85,,,,,0,"percent of total billed charges","85% of total billed charges",1015,25,,,,,0,"percent of total billed charges","25% of total billed charges",1015,25,,,,,0,"percent of total billed charges","25% of total billed charges",1015,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",827.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3654,90,,,,,0,"percent of total billed charges","90% of total billed charges",1421,35,,,,,0,"percent of total billed charges","35% of total billed charges",2789.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3654,90,,,,,0,"percent of total billed charges","90% of total billed charges",2354.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",827.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3451,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",827.02,3654,
"CLOSE TREATMENT SHOULDER DISL W MANIPULA",2023545,CDM,450,RC,23545,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"CLOSED TREATMENT OF HIP",2027250,CDM,450,RC,27250,HCPCS,OUTPATIENT,,,1420,1136,,1207,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",289.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",802.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",802.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",802.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",802.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1278,90,,,,,0,"percent of total billed charges","90% of total billed charges",497,35,,,,,0,"percent of total billed charges","35% of total billed charges",975.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",823.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",289.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1207,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,1278,
"CLOSED TREATMENT OF PATELLAR DISLOCATION",2027562,CDM,450,RC,27562,HCPCS,OUTPATIENT,,,2990,2392,,2541.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",609.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2691,90,,,,,0,"percent of total billed charges","90% of total billed charges",1046.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2054.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1734.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",609.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2541.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,2691,
"CLOSED TX OF ANKLE DISLOCATION W ANETH",2027842,CDM,450,RC,27842,HCPCS,OUTPATIENT,,,6820,5456,,5797,85,,,,,0,"percent of total billed charges","85% of total billed charges",1705,25,,,,,0,"percent of total billed charges","25% of total billed charges",1705,25,,,,,0,"percent of total billed charges","25% of total billed charges",1705,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1389.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6138,90,,,,,0,"percent of total billed charges","90% of total billed charges",2387,35,,,,,0,"percent of total billed charges","35% of total billed charges",4685.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6138,90,,,,,0,"percent of total billed charges","90% of total billed charges",3955.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1389.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5797,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1389.23,6138,
"CLSD TX PELVIC RING FX",2027197,CDM,450,RC,27197,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"CLTX CLAVICULAR FX W/ MNPJ",2023505,CDM,450,RC,23505,HCPCS,OUTPATIENT,,,5000,4000,,4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",1250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",1750,35,,,,,0,"percent of total billed charges","35% of total billed charges",3435,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",2900,58,,,,,0,"percent of total billed charges","58% of total billed charges",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1018.5,4500,
"CLTX CLAVICULAR FX W/O MNPJ",2023500,CDM,450,RC,23500,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",137.5,607.5,
"CLTX MED ANKLE FX W/MNPJ",2027762,CDM,450,RC,27762,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"CLTX MEDIAL ANKLE FX",2027760,CDM,450,RC,27760,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"CLTX POST ANKLE FX",2027767,CDM,450,RC,27767,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"CLTX POST ANKLE FX W/MNPJ",2027768,CDM,450,RC,27768,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"CLTX PROX HUMRL FX W/O MNPJ",2023600,CDM,450,RC,23600,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,170.90,170.90,170.90,"1 through 10","fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",137.5,607.5,
"CLTX RDL FX/EPIIP",2025605,CDM,450,RC,25605,HCPCS,OUTPATIENT,,,3910,3128,,3323.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",977.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",977.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",977.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",796.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,2218.42,2218.42,2218.42,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3519,90,,,,,0,"percent of total billed charges","90% of total billed charges",1368.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2686.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3519,90,,,,,0,"percent of total billed charges","90% of total billed charges",2267.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",796.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3323.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",796.47,3519,
"CMPLX RPR E/N/E/L ADDL 5CM/<",2013153,CDM,450,RC,13153,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,855,
"CMPLX RPR S/A/L 1.1-2.5CM",2013120,CDM,450,RC,13120,HCPCS,OUTPATIENT,,,1795,1436,,1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",628.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1233.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1041.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.64,1615.5,
"CMPLX RPR TRUNK 1.1-2.5CM",2013100,CDM,450,RC,13100,HCPCS,OUTPATIENT,,,1795,1436,,1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1014.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1615.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",628.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1233.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1041.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",365.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1525.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.64,1615.5,
COLPORRHAPHY,2057200,CDM,450,RC,57200,HCPCS,OUTPATIENT,,,7250,5800,,6162.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1812.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1476.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6525,90,,,,,0,"percent of total billed charges","90% of total billed charges",2537.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4980.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6525,90,,,,,0,"percent of total billed charges","90% of total billed charges",4205,58,,,,,0,"percent of total billed charges","58% of total billed charges",1476.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6162.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1476.83,6525,
"CONTROL NASAL HEMORRAHAGE",2030905,CDM,450,RC,30905,HCPCS,OUTPATIENT,,,490,392,,416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",99.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",276.85,56.5,,1331.61,1331.61,1331.61,"1 through 10","percent of total billed charges","50.56% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",276.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",441,90,,,,,0,"percent of total billed charges","90% of total billed charges",171.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",336.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",284.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",99.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",416.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",99.81,441,
"CONTROL OF NOSEBLEED",2030903,CDM,450,RC,30903,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,91.84,91.84,91.84,"1 through 10","fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
CPR,2092950,CDM,450,RC,92950,HCPCS,OUTPATIENT,,,1055,844,,896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",214.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",596.08,56.5,,270.27,270.27,270.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",949.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",369.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",724.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",611.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",214.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,221.85,221.85,221.85,"1 through 10","fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",214.9,949.5,
"CREP H/A/5 CM OR LESS",2013133,CDM,450,RC,13133,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,612,
"CULDESAC PUNCTURE",2005022,CDM,450,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"CURETTE/TREAT CORNEA",2065435,CDM,450,RC,65435,HCPCS,OUTPATIENT,,,3000,2400,,2550,85,,,,,0,"percent of total billed charges","85% of total billed charges",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1144.19,130,,,,,0,"fee schedule","130% of CMS OPPS rate",611.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",897.75,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2700,90,,,,,0,"percent of total billed charges","90% of total billed charges",1050,35,,,,,0,"percent of total billed charges","35% of total billed charges",2061,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",792.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1740,58,,,,,0,"percent of total billed charges","58% of total billed charges",611.1,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2550,85,,,,,0,"percent of total billed charges","85% of total billed charges",880.15,100,,,,,0,"fee schedule","100% of CMS OPPS rate",611.1,2700,
"CUT DOWN CHILD/ADULT",2036491,CDM,450,RC,,,OUTPATIENT,,,1355,1084,,1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",474.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",930.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",785.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,1219.5,
"CUT DOWN INFANT",2036490,CDM,450,RC,36555,HCPCS,OUTPATIENT,,,1355,1084,,1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",474.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",930.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",785.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,1219.5,
"DBRDMT BONE 1ST 20 SQ CM/<",2011044,CDM,450,RC,11044,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"DBRDMT BONE EACH ADDL",2011047,CDM,450,RC,11047,HCPCS,OUTPATIENT,,,5527.49,4421.99,,4698.37,85,,,,,0,"percent of total billed charges","85% of total billed charges",1381.87,25,,,,,0,"percent of total billed charges","25% of total billed charges",1381.87,25,,,,,0,"percent of total billed charges","25% of total billed charges",1381.87,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4974.74,90,,,,,0,"percent of total billed charges","90% of total billed charges",1934.62,35,,,,,0,"percent of total billed charges","35% of total billed charges",3797.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4974.74,90,,,,,0,"percent of total billed charges","90% of total billed charges",3205.94,58,,,,,0,"percent of total billed charges","58% of total billed charges",1125.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4698.37,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125.95,4974.74,
"DBRDMT MUSC&FSCA EA ADDL",2011046,CDM,450,RC,11046,HCPCS,OUTPATIENT,,,1384,1107.2,,1176.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",346,25,,,,,0,"percent of total billed charges","25% of total billed charges",346,25,,,,,0,"percent of total billed charges","25% of total billed charges",346,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",281.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",781.96,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",781.96,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",781.96,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",781.96,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1245.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",484.4,35,,,,,0,"percent of total billed charges","35% of total billed charges",950.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1245.6,90,,,,,0,"percent of total billed charges","90% of total billed charges",802.72,58,,,,,0,"percent of total billed charges","58% of total billed charges",281.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1176.4,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",281.92,1245.6,
"DBRDMT SUBQ TISS EACH ADDL",2011045,CDM,450,RC,11045,HCPCS,OUTPATIENT,,,1315,1052,,1117.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",328.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",328.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",328.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",267.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",742.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1183.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",460.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",903.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1183.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",762.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",267.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1117.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",267.87,1183.5,
"DEB MUSC/FASCIA 20 SQ CM/<",2011043,CDM,450,RC,11043,HCPCS,OUTPATIENT,,,2350,1880,,1997.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",478.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1327.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1327.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1327.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1327.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2115,90,,,,,0,"percent of total billed charges","90% of total billed charges",822.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1614.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1363,58,,,,,0,"percent of total billed charges","58% of total billed charges",478.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1997.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",478.7,2115,
"DEBRID SKIN PRTL SUBCUTAN",2011042,CDM,450,RC,11042,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",536.75,56.5,,170.21,170.21,170.21,"1 through 10","percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,284.65,284.65,284.65,"1 through 10","fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",193.52,855,
"DEBRIDEMENT OF NAIL(S) 1-5  ANY METHOD",2011720,CDM,450,RC,11720,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",312.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,409.5,
"DECLOT VASCULAR DEVICE",2036593,CDM,450,RC,36593,HCPCS,OUTPATIENT,,,1350,1080,,1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",391.84,130,,,,,0,"fee schedule","130% of CMS OPPS rate",275,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",762.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",307.44,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1215,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",927.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.27,90,,,,,0,"fee schedule","90% of CMS OPPS rate",783,58,,,,,0,"percent of total billed charges","58% of total billed charges",275,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",301.42,100,,236.32,236.32,236.32,"1 through 10","fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1147.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.27,1215,
"DELIVER PLACENTA",2059414,CDM,450,RC,59414,HCPCS,OUTPATIENT,,,9000,7200,,7650,85,,,,,0,"percent of total billed charges","85% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1833.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",8100,90,,,,,0,"percent of total billed charges","90% of total billed charges",3150,35,,,,,0,"percent of total billed charges","35% of total billed charges",6183,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8100,90,,,,,0,"percent of total billed charges","90% of total billed charges",5220,58,,,,,0,"percent of total billed charges","58% of total billed charges",1833.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7650,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1833.3,8100,
"DIAGNOSTIC ANOSCOPY SPX",2046600,CDM,450,RC,46600,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,12.41,12.41,12.41,"1 through 10","percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"DISLOC ANKLE TX",2027840,CDM,450,RC,27840,HCPCS,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",268.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.76,427.5,
"DISLOC ELBOW CHILD(NURSEMAIDS)",2024640,CDM,450,RC,24640,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"DISLOC ELBOW TX",2024600,CDM,450,RC,24600,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"DISLOC ELBOW TX W ANEST",2024605,CDM,450,RC,24605,HCPCS,OUTPATIENT,,,5115,4092,,4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.93,20.37,,806.90,806.90,806.90,"1 through 10","percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1790.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3514.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2966.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.93,4603.5,
"DISLOC FINGER TX",2026770,CDM,450,RC,26770,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,1245.56,1245.56,1245.56,"1 through 10","percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"DISLOC JAW TX",2021480,CDM,450,RC,21480,HCPCS,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",372.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",134.44,594,
"DISLOC KNEE TX",2027550,CDM,450,RC,27550,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"DISLOC SHOULDER W ANES",2023655,CDM,450,RC,23655,HCPCS,OUTPATIENT,,,4960,3968,,4216,85,,,,,0,"percent of total billed charges","85% of total billed charges",1240,25,,,,,0,"percent of total billed charges","25% of total billed charges",1240,25,,,,,0,"percent of total billed charges","25% of total billed charges",1240,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1010.35,20.37,,782.44,782.44,782.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",2000,56.5,,1934.74,1934.74,1934.74,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4464,90,,,,,0,"percent of total billed charges","90% of total billed charges",1736,35,,,,,0,"percent of total billed charges","35% of total billed charges",3407.52,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4464,90,,,,,0,"percent of total billed charges","90% of total billed charges",2876.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1010.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4216,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1010.35,4464,
"DISLOC SHOULDER WO ANESTH",2023650,CDM,450,RC,23650,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,1754.81,1754.81,1754.81,"1 through 10","percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"DISLOC THUMB TX",2026641,CDM,450,RC,26641,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"DISLOCATED HIP CLOSED",2027252,CDM,450,RC,27252,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,5625,
"DISLOCATION INTERPHALANGEAL JOINT CLOSED",2028665,CDM,450,RC,28665,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"DISSOLVE CLOT HEART VESSEL",2092977,CDM,450,RC,92977,HCPCS,OUTPATIENT,,,900,720,,765,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",391.84,130,,,,,0,"fee schedule","130% of CMS OPPS rate",183.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",508.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",508.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",508.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",508.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",307.44,102,,,,,0,"fee schedule","102% of CMS OPPS rate",810,90,,,,,0,"percent of total billed charges","90% of total billed charges",315,35,,,,,0,"percent of total billed charges","35% of total billed charges",618.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.27,90,,,,,0,"fee schedule","90% of CMS OPPS rate",522,58,,,,,0,"percent of total billed charges","58% of total billed charges",183.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",765,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",183.33,810,
"DO NOT USE",2027625,CDM,450,RC,,,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,,,,0,"percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,576,
"DRAIN EXTERNAL EAR LESION",2069000,CDM,450,RC,69000,HCPCS,OUTPATIENT,,,1805,1444,,1534.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",367.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1019.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1624.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",631.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1240.04,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1046.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",367.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1534.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.68,1624.5,
"DRAIN FINGER ABSC COMPLICATED",2026011,CDM,450,RC,26011,HCPCS,OUTPATIENT,,,2990,2392,,2541.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",747.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",747.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",747.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",609.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1689.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2691,90,,,,,0,"percent of total billed charges","90% of total billed charges",1046.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2054.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2691,90,,,,,0,"percent of total billed charges","90% of total billed charges",1734.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",609.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2541.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",609.06,2691,
"DRAIN FINGER ABSESS SIMPLE",2026010,CDM,450,RC,26010,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,119.83,119.83,119.83,"1 through 10","percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,697.5,
"DRAIN/INJ JOINT/BURSA W/US",2020604,CDM,450,RC,20604,HCPCS,OUTPATIENT,,,850,680,,722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",765,90,,,,,0,"percent of total billed charges","90% of total billed charges",297.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",583.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",493,58,,,,,0,"percent of total billed charges","58% of total billed charges",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",173.15,765,
"DRAIN/INJ JOINT/BURSA W/US",2020606,CDM,450,RC,20606,HCPCS,OUTPATIENT,,,1975,1580,,1678.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",402.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1115.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1115.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1115.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1115.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1777.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",691.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1356.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1145.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",402.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1678.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",402.31,1777.5,
"DRAIN/INJ JOINT/BUSA/W/US",2020611,CDM,450,RC,20611,HCPCS,OUTPATIENT,,,850,680,,722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",765,90,,,,,0,"percent of total billed charges","90% of total billed charges",297.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",583.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",493,58,,,,,0,"percent of total billed charges","58% of total billed charges",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",173.15,765,
"DRAINAGE MOUTH ROOF LESION",2042000,CDM,450,RC,42000,HCPCS,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",170.09,751.5,
"DRAINAGE OF ABSCESS CYST",2041800,CDM,450,RC,41800,HCPCS,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,661.5,
"DRAINAGE OF SCROTAL WALL ABSCESS",2055100,CDM,450,RC,55100,HCPCS,OUTPATIENT,,,3415,2732,,2902.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",853.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",853.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",853.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",695.64,20.37,,538.72,538.72,538.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",3073.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1195.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2346.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3073.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1980.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",695.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2902.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",695.64,3073.5,
"DRAINAGE OF TONSIL ABSCESS",2042700,CDM,450,RC,42700,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,675,
"EAR IRRIGATION",2069210,CDM,450,RC,69210,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,243,
"EAST GEORGIA ER LEVEL IV",2000000,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,4225,3380,,3591.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",503.04,130,,,,,0,"fee schedule","130% of CMS OPPS rate",860.63,20.37,,228.06,186.43,233.36,"1 through 10","percent of total billed charges","20.37% of total billed charges",4225,100,,660.75,88.64,916.92,38,"percent of total billed charges","100% of total billed charges",4225,100,,,,,0,"percent of total billed charges","100% of total billed charges",4225,100,,,,,0,"percent of total billed charges","100% of total billed charges",4225,100,,,,,0,"percent of total billed charges","100% of total billed charges",394.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3802.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1478.75,35,,216.47,216.47,216.47,"1 through 10","percent of total billed charges","35% of total billed charges",2902.58,68.7,,688.66,524.70,852.61,"1 through 10","percent of total billed charges","68.7% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.25,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2450.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",860.63,20.37,,223.51,76.52,223.51,15,"percent of total billed charges","20.37% of total billed charges",386.95,100,,303.37,299.38,303.37,159,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3591.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.25,4225,
"ELECTROCARDIOGRAM REPORT",2093010,CDM,450,RC,93010,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,866.92,62.17,1066.92,18,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"EMERGENCY DEPARTMENT VISIT HIGH/URGENT S",2199284,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,1400,1120,,1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",503.04,130,,,,,0,"fee schedule","130% of CMS OPPS rate",285.18,20.37,,228.06,186.43,233.36,"1 through 10","percent of total billed charges","20.37% of total billed charges",1400,100,,660.75,88.64,916.92,38,"percent of total billed charges","100% of total billed charges",1400,100,,,,,0,"percent of total billed charges","100% of total billed charges",1400,100,,,,,0,"percent of total billed charges","100% of total billed charges",1400,100,,,,,0,"percent of total billed charges","100% of total billed charges",394.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1260,90,,,,,0,"percent of total billed charges","90% of total billed charges",490,35,,216.47,216.47,216.47,"1 through 10","percent of total billed charges","35% of total billed charges",961.8,68.7,,688.66,524.70,852.61,"1 through 10","percent of total billed charges","68.7% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.25,90,,,,,0,"fee schedule","90% of CMS OPPS rate",812,58,,,,,0,"percent of total billed charges","58% of total billed charges",285.18,20.37,,223.51,76.52,223.51,15,"percent of total billed charges","20.37% of total billed charges",386.95,100,,303.37,299.38,303.37,159,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.18,1400,
"EMERGENCY DEPARTMENT VISIT LIMITED/MINOR",2199281,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50,,,57.01,45.50,58.35,"1 through 10","case rate","pays based on per visit rate",350,100,,190.00,59.93,364.40,"1 through 10","percent of total billed charges","100% of total billed charges",350,100,,,,,0,"percent of total billed charges","100% of total billed charges",350,100,,,,,0,"percent of total billed charges","100% of total billed charges",350,100,,,,,0,"percent of total billed charges","100% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,55.88,55.88,55.88,"1 through 10","percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,65.60,57.82,73.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50,350,
"EMERGENCY DEPARTMENT VISIT LOW/MODER SEV",2199282,CDM,450,RC,99282,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",187.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,157.75,157.75,157.75,"1 through 10","percent of total billed charges","20.37% of total billed charges",1000,100,,723.00,75.02,885.00,"1 through 10","percent of total billed charges","100% of total billed charges",1000,100,,,,,0,"percent of total billed charges","100% of total billed charges",1000,100,,,,,0,"percent of total billed charges","100% of total billed charges",1000,100,,,,,0,"percent of total billed charges","100% of total billed charges",146.77,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,78.32,78.32,78.32,"1 through 10","percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,159.65,159.65,159.65,"1 through 10","percent of total billed charges","20.37% of total billed charges",143.9,100,,112.82,112.82,112.82,16,"fee schedule","100% of CMS OPPS rate",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.51,1000,
"EMERGENCY DEPARTMENT VISIT MODERATE SEVE",2199283,CDM,450,RC,99283,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.1,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,55.30,40.13,167.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",1200,100,,800.19,176.54,910.90,37,"percent of total billed charges","100% of total billed charges",1200,100,,,,,0,"percent of total billed charges","100% of total billed charges",1200,100,,,,,0,"percent of total billed charges","100% of total billed charges",1200,100,,,,,0,"percent of total billed charges","100% of total billed charges",256.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,185.54,185.54,185.54,"1 through 10","percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",226.45,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,191.58,73.07,191.58,20,"percent of total billed charges","20.37% of total billed charges",251.62,100,,197.27,197.27,197.27,77,"fee schedule","100% of CMS OPPS rate",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",226.45,1200,
"EMERGENCY DEPARTMENT VISIT SEVERITY/THRE",2199285,CDM,450,RC,99285,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",724.29,130,,,,,0,"fee schedule","130% of CMS OPPS rate",374.81,20.37,,265.54,238.18,292.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",1840,100,,853.54,396.17,1066.92,39,"percent of total billed charges","100% of total billed charges",1840,100,,,,,0,"percent of total billed charges","100% of total billed charges",1840,100,,,,,0,"percent of total billed charges","100% of total billed charges",1840,100,,,,,0,"percent of total billed charges","100% of total billed charges",568.29,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,293.76,293.76,293.76,"1 through 10","percent of total billed charges","35% of total billed charges",1264.08,68.7,,717.60,717.60,717.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",501.43,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,293.76,250.67,293.76,19,"percent of total billed charges","20.37% of total billed charges",557.14,100,,436.81,436.81,1886.38,262,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",374.81,1840,
"EPISIOTOMY/VAGINAL REPAIR",2059300,CDM,450,RC,59300,HCPCS,OUTPATIENT,,,3300,2640,,2805,85,,,,,0,"percent of total billed charges","85% of total billed charges",825,25,,,,,0,"percent of total billed charges","25% of total billed charges",825,25,,,,,0,"percent of total billed charges","25% of total billed charges",825,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",672.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2970,90,,,,,0,"percent of total billed charges","90% of total billed charges",1155,35,,,,,0,"percent of total billed charges","35% of total billed charges",2267.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2970,90,,,,,0,"percent of total billed charges","90% of total billed charges",1914,58,,,,,0,"percent of total billed charges","58% of total billed charges",672.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2805,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",672.21,2970,
"ER NON-URGENT EMC",2000014,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50,,,57.01,45.50,58.35,"1 through 10","case rate","pays based on per visit rate",275,100,,190.00,59.93,364.40,"1 through 10","percent of total billed charges","100% of total billed charges",275,100,,,,,0,"percent of total billed charges","100% of total billed charges",275,100,,,,,0,"percent of total billed charges","100% of total billed charges",275,100,,,,,0,"percent of total billed charges","100% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,55.88,55.88,55.88,"1 through 10","percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,65.60,57.82,73.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50,275,
"EXC TR-EXT B9+ MARG >4.0 CM",2011406,CDM,450,RC,11406,HCPCS,OUTPATIENT,,,6500,5200,,5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,1774.74,1774.74,1774.74,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",2275,35,,,,,0,"percent of total billed charges","35% of total billed charges",4465.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",3770,58,,,,,0,"percent of total billed charges","58% of total billed charges",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,5850,
"EXCISION BENIGN LESION .5CM OR LESS",2011420,CDM,450,RC,11420,HCPCS,OUTPATIENT,,,3415,2732,,2902.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",853.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",853.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",853.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",695.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1929.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",3073.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1195.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2346.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3073.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1980.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",695.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2902.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",695.64,3073.5,
"EXCISION OF LESSION MOUTH W/SIMPLE REPAI",2040812,CDM,450,RC,40812,HCPCS,OUTPATIENT,,,1285,1028,,1092.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",261.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1156.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",449.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",882.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1156.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",745.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",261.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1092.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",261.75,1156.5,
"EXPLORATION OF CHEST",2032100,CDM,450,RC,32100,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",509.25,2500,
"EXPLORATION WOUND EXTREMITY",2020103,CDM,450,RC,20103,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,418.5,
"EXPLORE/REPAIR CHEST",2032110,CDM,450,RC,32110,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",2500,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",509.25,2500,
"EXTENDED CARE",2099205,CDM,450,RC,99205,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",80,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,20.37,,101.48,75.48,127.48,"1 through 10","percent of total billed charges","20.37% of total billed charges",180.8,56.5,,164.16,142.70,207.79,13,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,288.99,288.99,288.99,"1 through 10","percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,192.49,192.49,192.49,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",65.18,288,
"EXTENDED EMERGENCY ROOM",2099203,CDM,450,RC,99203,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,37.86,11.86,63.86,"1 through 10","percent of total billed charges","20.37% of total billed charges",25.43,56.5,,82.00,55.80,105.80,14,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,107.17,105.42,108.91,"1 through 10","percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"EXTENSOR TENDON REPAIR",2026418,CDM,450,RC,26418,HCPCS,OUTPATIENT,,,7375,5900,,6268.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1843.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1843.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1843.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1502.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6637.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2581.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",5066.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6637.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4277.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1502.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6268.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1502.29,6637.5,
"FACIAL LAC INTRM <2.5CM",2012051,CDM,450,RC,12051,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",138.52,612,
"FACIAL LAC INTRM 2.6 - 5.0CM",2012052,CDM,450,RC,12052,HCPCS,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,359.37,359.37,359.37,"1 through 10","percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",149.72,661.5,
"FACIAL LAC SIMPLE <2.5CM",2012011,CDM,450,RC,12011,HCPCS,OUTPATIENT,,,615,492,,522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",347.48,56.5,,1445.78,1445.27,1574.29,"1 through 10","percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",553.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",215.25,35,,98.19,98.19,98.19,"1 through 10","percent of total billed charges","35% of total billed charges",422.51,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",356.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.28,553.5,
"FACIAL LAC SIMPLE 2.6-5.0CM",2012013,CDM,450,RC,12013,HCPCS,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,105.92,105.92,105.92,"1 through 10","percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",139.53,616.5,
"FACIAL LAC SIMPLE 5.1-7.5",2012014,CDM,450,RC,12014,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",133.42,589.5,
"FACIAL LAC SIMPLE 7.6-12.5",2012015,CDM,450,RC,12015,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",147.68,652.5,
"FB REMOVAL EAR",2000011,CDM,450,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"FB REMOVAL EYE",2065205,CDM,450,RC,65205,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,603,
"FB REMOVAL EYE",2065210,CDM,450,RC,65210,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
"FB REMOVAL FOOT SUBCUT",2028190,CDM,450,RC,28190,HCPCS,OUTPATIENT,,,815,652,,692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",285.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",559.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",472.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.02,831.18,
"FB REMOVAL FOREIGN",2010120,CDM,450,RC,10120,HCPCS,OUTPATIENT,,,1075,860,,913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",607.38,56.5,,772.06,723.92,820.20,"1 through 10","percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",607.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",967.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",376.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",738.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",623.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",218.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",913.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",218.98,967.5,
"FB REMOVAL MOUTH",2040804,CDM,450,RC,40804,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.59,130,,,,,0,"fee schedule","130% of CMS OPPS rate",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",49.91,1107.59,
"FB REMOVAL MOUTH",2040805,CDM,450,RC,40805,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",601.6,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",472.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",416.49,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",462.77,100,,,,,0,"fee schedule","100% of CMS OPPS rate",325.92,1440,
"FB REMOVAL MUSCLE",2020520,CDM,450,RC,20520,HCPCS,OUTPATIENT,,,1025,820,,871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",358.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",704.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",594.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",208.79,922.5,
"FB REMOVAL NASAL",2030300,CDM,450,RC,30300,HCPCS,OUTPATIENT,,,670,536,,569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",378.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",603,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",460.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",388.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",136.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",569.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,603,
"FETAL MONITOR",2059050,CDM,450,RC,59050,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"FINE NEEDLE ASPIRATION WO IMAGE",2010021,CDM,450,RC,10021,HCPCS,OUTPATIENT,,,1330,1064,,1130.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",270.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",751.45,56.5,,67.92,67.92,67.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",751.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",751.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",751.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1197,90,,,,,0,"percent of total billed charges","90% of total billed charges",465.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",913.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",771.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",270.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1130.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",270.92,1197,
"FOLEY CATH INSERTION DIFF",2051703,CDM,450,RC,51703,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,111.47,111.47,111.47,"1 through 10","fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",115.09,508.5,
"FOLEY CATH INSERTION SIMP",2051702,CDM,450,RC,51702,HCPCS,OUTPATIENT,,,840,672,,714,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",474.6,56.5,,604.54,451.61,1070.84,"1 through 10","percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",294,35,,129.88,129.88,129.88,"1 through 10","percent of total billed charges","35% of total billed charges",577.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",487.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",171.11,20.37,,134.11,134.11,134.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",714,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,756,
"FOLEY CATH INSERTION SIMP",4051702,CDM,450,RC,51702,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",189.28,56.5,,604.54,451.61,1070.84,"1 through 10","percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,129.88,129.88,129.88,"1 through 10","percent of total billed charges","35% of total billed charges",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,134.11,134.11,134.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",68.24,301.5,
"FX ANKLE CLOSED REDUCTION W/MANIPULATION",2027810,CDM,450,RC,27810,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"FX CALCANEAL CLOSED",2028400,CDM,450,RC,28400,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"FX CARPOMETACARPAL  CLOSED W/MANIPULATIO",2026645,CDM,450,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"FX ELBOW CLOSED",2024655,CDM,450,RC,24655,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"FX HUMERUS CLOSED",2024500,CDM,450,RC,24500,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"FX HUMERUS TX ELBOW",2023605,CDM,450,RC,,,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"FX METACARPAL CLOSED",2026605,CDM,450,RC,26605,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"FX NOSE CLOSED",2021310,CDM,450,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"FX PATELLA CLOSED",2027560,CDM,450,RC,27560,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"FX PHALANGEAL, DISTAL  CLOSED",2026755,CDM,450,RC,26755,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"FX PHALANGEAL, PROXIMAL  CLOSED",2026725,CDM,450,RC,26725,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"FX RAD & ULNAR CLOSED W/MANIPULATION",2025565,CDM,450,RC,25565,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"FX RAD OR ULNAR CLOSED",2025560,CDM,450,RC,25560,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"FX RADIUS CLOSED",2025500,CDM,450,RC,25500,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,113.36,113.36,113.36,"1 through 10","percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"FX TIBIA CLOSED",2027752,CDM,450,RC,27752,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"FX TOE CLOSED",2028490,CDM,450,RC,28490,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"FX TOE CLOSED",2028510,CDM,450,RC,28510,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"FX ULNAR CLOSED",2025530,CDM,450,RC,25530,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,639,
"GASTRIC LAVAGE",2091105,CDM,450,RC,43753,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",73.33,367.87,
"GASTROSTOMY TUBE REPLACE",2043760,CDM,450,RC,43762,HCPCS,OUTPATIENT,,,835,668,,709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",471.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",751.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",292.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",573.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",484.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",170.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,173.26,173.26,173.26,"1 through 10","fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",709.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",170.09,751.5,
"HEMORRHOID  EXTERNAL",2046083,CDM,450,RC,,,OUTPATIENT,,,1125,900,,956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",281.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",635.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",393.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",772.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1012.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",652.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",229.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",956.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",229.16,1012.5,
"I & D  ABSCESS COMPLICATED",2010061,CDM,450,RC,10061,HCPCS,OUTPATIENT,,,1455,1164,,1236.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",296.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",822.08,56.5,,205.10,99.11,801.90,"1 through 10","percent of total billed charges","50.56% of total billed charges",822.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",822.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",822.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1309.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",509.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",999.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",843.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",296.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,284.65,284.65,284.65,"1 through 10","fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1236.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",296.38,1309.5,
"I & D  PILONIDAL CYST COMP",2010081,CDM,450,RC,10081,HCPCS,OUTPATIENT,,,2025,1620,,1721.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",412.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1144.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1144.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1144.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1144.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1822.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",708.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1391.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1174.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",412.49,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1721.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",412.49,1822.5,
"I & D  PILONIDAL CYST, SIMPLE",2010080,CDM,450,RC,10080,HCPCS,OUTPATIENT,,,720,576,,612,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",146.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",648,90,,,,,0,"percent of total billed charges","90% of total billed charges",252,35,,,,,0,"percent of total billed charges","35% of total billed charges",494.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",417.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",146.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",612,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",146.66,831.18,
"I & D PERIANAL ABSCESS",2046050,CDM,450,RC,46050,HCPCS,OUTPATIENT,,,2560,2048,,2176,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",521.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1446.4,56.5,,418.90,418.90,418.90,"1 through 10","percent of total billed charges","50.56% of total billed charges",1446.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1446.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1446.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2304,90,,,,,0,"percent of total billed charges","90% of total billed charges",896,35,,,,,0,"percent of total billed charges","35% of total billed charges",1758.72,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1484.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",521.47,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2176,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",521.47,2304,
"I & D SIMPLE ABCESS",1510060,CDM,450,RC,10060,HCPCS,OUTPATIENT,,,505,404,,429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",102.87,20.37,,117.28,117.28,117.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",285.33,56.5,,749.81,121.30,1642.50,"1 through 10","percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",454.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.75,35,,114.95,114.95,114.95,"1 through 10","percent of total billed charges","35% of total billed charges",346.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",292.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,141.57,141.57,141.57,"1 through 10","fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102.87,454.5,
"I & D SIMPLE ABCESS",2010060,CDM,450,RC,10060,HCPCS,OUTPATIENT,,,720,576,,612,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",146.66,20.37,,117.28,117.28,117.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",406.8,56.5,,749.81,121.30,1642.50,"1 through 10","percent of total billed charges","50.56% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",406.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",648,90,,,,,0,"percent of total billed charges","90% of total billed charges",252,35,,114.95,114.95,114.95,"1 through 10","percent of total billed charges","35% of total billed charges",494.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",417.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",146.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,141.57,141.57,141.57,"1 through 10","fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",612,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",146.66,648,
"I&D BARTHOLINS GLAND ABSCESS",2056420,CDM,450,RC,56420,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",237.65,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",186.46,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",164.52,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,697.5,
"I&D HEMATOMA SEROMA FLUID",2000002,CDM,450,RC,10140,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,855,
"I&D PERIRECTAL OR ISCHIAL ABSCESS",2046040,CDM,450,RC,46040,HCPCS,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,471.55,471.55,471.55,"1 through 10","percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.63,1392.91,
"I&D VULVA PERINEAL ABSCESS",2056405,CDM,450,RC,56405,HCPCS,OUTPATIENT,,,605,484,,514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",359.35,130,,,,,0,"fee schedule","130% of CMS OPPS rate",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",281.95,102,,,,,0,"fee schedule","102% of CMS OPPS rate",544.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",415.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.78,90,,,,,0,"fee schedule","90% of CMS OPPS rate",350.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",276.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",123.24,544.5,
"IM INJECTION ANTIBIOTIC",2090772,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IM INJECTION IMMUNE GLOBULIN",2090281,CDM,450,RC,90281,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"IM INJECTION OR SUBCUTANEOUS",2090773,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IM INJECTION VACCINE",2090471,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IM INJECTION VACCINE",4090471,CDM,450,RC,90471,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IN & OUT CATHETERIZATION",1051701,CDM,450,RC,51701,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.57,382.5,
"IN & OUT CATHETERIZATION",2051701,CDM,450,RC,51701,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.57,382.5,
"INC&RMVL FB SUBQ TISS COMP",2010121,CDM,450,RC,10121,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"INCISION OF HEART SAC",2033020,CDM,450,RC,33020,HCPCS,OUTPATIENT,,,5000,4000,,4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4500,90,,,,,0,"percent of total billed charges","90% of total billed charges",1750,35,,,,,0,"percent of total billed charges","35% of total billed charges",3435,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2900,58,,,,,0,"percent of total billed charges","58% of total billed charges",1018.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4250,85,,,,,0,"percent of total billed charges","85% of total billed charges",5000,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1018.5,5000,
"INCISION OF WINDPIPE",2031605,CDM,450,RC,31605,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,675,
"INITIAL DRIP/IVPB",2096365,CDM,450,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"INJ ANES LUMBAR/THORACIC",2064520,CDM,450,RC,64520,HCPCS,OUTPATIENT,,,955,764,,811.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1051.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",194.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",539.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",539.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",539.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",539.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",825.21,102,,,,,0,"fee schedule","102% of CMS OPPS rate",859.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",334.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",656.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",728.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",553.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",194.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",811.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",194.53,1051.74,
"INJ CORPORA CAVERNOSA",2054235,CDM,450,RC,54235,HCPCS,OUTPATIENT,,,1235,988,,1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",848.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",716.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,1111.5,
"INJ PARAVERT F JNT C/T 1 LEV",2064490,CDM,450,RC,64490,HCPCS,OUTPATIENT,,,2400,1920,,2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1051.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",825.21,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2160,90,,,,,0,"percent of total billed charges","90% of total billed charges",840,35,,,,,0,"percent of total billed charges","35% of total billed charges",1648.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",728.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1392,58,,,,,0,"percent of total billed charges","58% of total billed charges",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",488.88,2160,
"INJ PARAVERT F JNT L/S 1 LEV",2064493,CDM,450,RC,64493,HCPCS,OUTPATIENT,,,2400,1920,,2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1051.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1356,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",825.21,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2160,90,,,,,0,"percent of total billed charges","90% of total billed charges",840,35,,,,,0,"percent of total billed charges","35% of total billed charges",1648.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",728.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1392,58,,,,,0,"percent of total billed charges","58% of total billed charges",488.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2040,85,,,,,0,"percent of total billed charges","85% of total billed charges",809.04,100,,,,,0,"fee schedule","100% of CMS OPPS rate",488.88,2160,
"INJ SNGLE TNDN SHTH LIGAM",2020550,CDM,450,RC,,,OUTPATIENT,,,500,400,,425,85,,,,,0,"percent of total billed charges","85% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",282.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",175,35,,,,,0,"percent of total billed charges","35% of total billed charges",343.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",450,90,,,,,0,"percent of total billed charges","90% of total billed charges",290,58,,,,,0,"percent of total billed charges","58% of total billed charges",101.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",425,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",101.85,450,
"INJECT SACROILIAC JOINT",2027096,CDM,450,RC,27096,HCPCS,OUTPATIENT,,,9250,7400,,7862.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1884.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",8325,90,,,,,0,"percent of total billed charges","90% of total billed charges",3237.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6354.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8325,90,,,,,0,"percent of total billed charges","90% of total billed charges",5365,58,,,,,0,"percent of total billed charges","58% of total billed charges",1884.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7862.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1884.23,8325,
"INJECT SKIN LESIONS </W 7",2011900,CDM,450,RC,11900,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,900,
"INJECT TRIGGER POINTS 3/>",2020553,CDM,450,RC,20553,HCPCS,OUTPATIENT,,,850,680,,722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",480.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",765,90,,,,,0,"percent of total billed charges","90% of total billed charges",297.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",583.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",493,58,,,,,0,"percent of total billed charges","58% of total billed charges",173.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",722.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",173.15,765,
"INS TEMP BLADDER CATH",2051705,CDM,450,RC,51705,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,697.5,
"INSERT CARD ELECTRODES DUAL",2033211,CDM,450,RC,33211,HCPCS,OUTPATIENT,,,24250,19400,,20612.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6062.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6062.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6062.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4939.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",21825,90,,,,,0,"percent of total billed charges","90% of total billed charges",8487.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",16659.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21825,90,,,,,0,"percent of total billed charges","90% of total billed charges",14065,58,,,,,0,"percent of total billed charges","58% of total billed charges",4939.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20612.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,21825,
"INSERT CATH PLEURA W/O IMAGE",2032556,CDM,450,RC,32556,HCPCS,OUTPATIENT,,,6835,5468,,5809.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1708.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1708.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1708.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1392.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6151.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2392.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",4695.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6151.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3964.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1392.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5809.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1392.29,6151.5,
"INSERT ELECTRD/PM CATH SNGL",2033210,CDM,450,RC,33210,HCPCS,OUTPATIENT,,,24250,19400,,20612.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6062.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6062.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6062.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4939.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",21825,90,,,,,0,"percent of total billed charges","90% of total billed charges",8487.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",16659.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",21825,90,,,,,0,"percent of total billed charges","90% of total billed charges",14065,58,,,,,0,"percent of total billed charges","58% of total billed charges",4939.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20612.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,21825,
"INSERT NEEDLE BONE CAVITY",2036680,CDM,450,RC,36680,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
"INSERT NON-TUNNEL CV CATH",2036555,CDM,450,RC,36555,HCPCS,OUTPATIENT,,,9000,7200,,7650,85,,,,,0,"percent of total billed charges","85% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1833.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",8100,90,,,,,0,"percent of total billed charges","90% of total billed charges",3150,35,,,,,0,"percent of total billed charges","35% of total billed charges",6183,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8100,90,,,,,0,"percent of total billed charges","90% of total billed charges",5220,58,,,,,0,"percent of total billed charges","58% of total billed charges",1833.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7650,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1833.3,8100,
"INSERT TUNNELED CV CATH",2036558,CDM,450,RC,36558,HCPCS,OUTPATIENT,,,12050,9640,,10242.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",3012.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3012.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",3012.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2454.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",10845,90,,,,,0,"percent of total billed charges","90% of total billed charges",4217.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",8278.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10845,90,,,,,0,"percent of total billed charges","90% of total billed charges",6989,58,,,,,0,"percent of total billed charges","58% of total billed charges",2454.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",10242.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,10845,
"INSERTION CATHETER ARTERY",2036620,CDM,450,RC,36620,HCPCS,OUTPATIENT,,,1500,1200,,1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",375,25,,,,,0,"percent of total billed charges","25% of total billed charges",375,25,,,,,0,"percent of total billed charges","25% of total billed charges",375,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",525,35,,,,,0,"percent of total billed charges","35% of total billed charges",1030.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",870,58,,,,,0,"percent of total billed charges","58% of total billed charges",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",305.55,1350,
"INSERTION OF CHEST TUBE",2032551,CDM,450,RC,32551,HCPCS,OUTPATIENT,,,3315,2652,,2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",828.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1872.98,56.5,,1348.27,1348.27,1348.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1872.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1160.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2277.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2983.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1922.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",675.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1106.75,1106.75,1106.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2817.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",675.27,2983.5,
"INSJ PICC + 5 YR W/O IMAGING",2036569,CDM,450,RC,36569,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,1397.27,1397.27,1397.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"INSJ PICC < 5 YR W/O IMAGING",2036568,CDM,450,RC,36568,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"INSJ PICC RS&I 5 YR",2036572,CDM,450,RC,36572,HCPCS,OUTPATIENT,,,1800,1440,,1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",730.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",573.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1620,90,,,,,0,"percent of total billed charges","90% of total billed charges",630,35,,,,,0,"percent of total billed charges","35% of total billed charges",1236.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",505.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1044,58,,,,,0,"percent of total billed charges","58% of total billed charges",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",561.83,100,,,,,0,"fee schedule","100% of CMS OPPS rate",366.66,1620,
"INSJ PICC RS&I 5 YR +",2036573,CDM,450,RC,36573,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"INTERROG EVL PM/LDLS PM IP",2093288,CDM,450,RC,93288,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",44.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",34.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.49,90,,,,,0,"fee schedule","90% of CMS OPPS rate",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",15.28,67.5,
"INTMD RPR FACE/MM >30CM",2012057,CDM,450,RC,12057,HCPCS,OUTPATIENT,,,1140,912,,969,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",232.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1026,90,,,,,0,"percent of total billed charges","90% of total billed charges",399,35,,,,,0,"percent of total billed charges","35% of total billed charges",783.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",661.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",232.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",969,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",232.22,1026,
"INTMD RPR FACE/MM 12.6-20CM",2012055,CDM,450,RC,12055,HCPCS,OUTPATIENT,,,1140,912,,969,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",232.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1026,90,,,,,0,"percent of total billed charges","90% of total billed charges",399,35,,,,,0,"percent of total billed charges","35% of total billed charges",783.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",661.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",232.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",969,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",232.22,1026,
"INTMD RPR FACE/MM 20.1-30.0",2012056,CDM,450,RC,12056,HCPCS,OUTPATIENT,,,1140,912,,969,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",232.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",644.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1026,90,,,,,0,"percent of total billed charges","90% of total billed charges",399,35,,,,,0,"percent of total billed charges","35% of total billed charges",783.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",661.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",232.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",969,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",232.22,1026,
"INTMD RPR N-HF/GENIT >30.0CM",2012047,CDM,450,RC,12047,HCPCS,OUTPATIENT,,,5215,4172,,4432.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2160.96,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1062.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695.53,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4693.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1825.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3582.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1496.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3024.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1062.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4432.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1662.29,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1062.3,4693.5,
"INTMD RPR N-HF/GENIT 12.6-20",2012045,CDM,450,RC,12045,HCPCS,OUTPATIENT,,,1800,1440,,1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1620,90,,,,,0,"percent of total billed charges","90% of total billed charges",630,35,,,,,0,"percent of total billed charges","35% of total billed charges",1236.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1044,58,,,,,0,"percent of total billed charges","58% of total billed charges",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",366.66,1620,
"INTMD RPR N-HF/GENIT 20.1-30",2012046,CDM,450,RC,12046,HCPCS,OUTPATIENT,,,1800,1440,,1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1620,90,,,,,0,"percent of total billed charges","90% of total billed charges",630,35,,,,,0,"percent of total billed charges","35% of total billed charges",1236.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1044,58,,,,,0,"percent of total billed charges","58% of total billed charges",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",366.66,1620,
"INTMD RPR N-HF/GENIT7.6-12.5",2012044,CDM,450,RC,12044,HCPCS,OUTPATIENT,,,1800,1440,,1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1017,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1620,90,,,,,0,"percent of total billed charges","90% of total billed charges",630,35,,,,,0,"percent of total billed charges","35% of total billed charges",1236.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1044,58,,,,,0,"percent of total billed charges","58% of total billed charges",366.66,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1530,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",366.66,1620,
"INTRO OF NEEDLE OR ENTRACATHETER",2036000,CDM,450,RC,36000,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"INTUBATION EMERGENCY",2031500,CDM,450,RC,31500,HCPCS,OUTPATIENT,,,1055,844,,896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",214.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",596.08,56.5,,1545.78,1337.27,1754.29,"1 through 10","percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",596.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",949.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",369.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",724.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",611.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",214.9,20.37,,168.44,168.44,168.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",211.02,100,,165.44,165.44,165.44,"1 through 10","fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",896.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,949.5,
"INTUBATION, ENDOTRACHEAL EMERGENCY",1031500,CDM,450,RC,31500,HCPCS,OUTPATIENT,,,2680,2144,,2278,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",545.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1514.2,56.5,,1545.78,1337.27,1754.29,"1 through 10","percent of total billed charges","50.56% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1514.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2412,90,,,,,0,"percent of total billed charges","90% of total billed charges",938,35,,,,,0,"percent of total billed charges","35% of total billed charges",1841.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1554.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",545.92,20.37,,168.44,168.44,168.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",211.02,100,,165.44,165.44,165.44,"1 through 10","fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2278,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,2412,
"IRRIGATION OF IMPLANTED VENOUS ACCESS",2096523,CDM,450,RC,96523,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",45.83,202.5,
"ITMD WOUND REPAIR FACE 7.6-12.5CM",2012054,CDM,450,RC,12054,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.31,805.5,
"IV  ADDITIONAL SEQUENTIAL INFUSION",2090767,CDM,450,RC,96367,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",56.02,20.37,,43.39,43.39,43.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",155.38,56.5,,64.02,64.02,64.02,"1 through 10","percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.95,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,39.91,36.72,43.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",64.67,100,,50.71,50.71,50.71,"1 through 10","fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",56.02,247.5,
"IV CONCURRENT INFUSION",1096368,CDM,450,RC,96368,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,21.65,21.65,21.65,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"IV CONCURRENT INFUSION",2096368,CDM,450,RC,96368,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,21.65,21.65,21.65,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"IV HYDRATION  ADDTL HR",2090761,CDM,450,RC,96361,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,866.92,238.80,896.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,28.74,28.74,28.74,"1 through 10","percent of total billed charges","35% of total billed charges",123.66,68.7,,70.20,70.20,70.20,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,316.12,316.12,316.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,82,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",36.67,162,
"IV HYDRATION INITIAL",2090760,CDM,450,RC,96360,HCPCS,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",129.35,20.37,,103.44,103.44,103.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",358.78,56.5,,165.00,145.40,184.60,"1 through 10","percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,101.37,101.37,101.37,"1 through 10","percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,57.47,28.74,100.18,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,43,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.35,571.5,
"IV INITIAL/THERAPEUTIC/PIGGYBACK",2090765,CDM,450,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"IV PUSH  EA ADDITIONAL  SAME  DRUG",2090776,CDM,450,RC,96376,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,70.99,70.99,70.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"IV PUSH  EA ADDITIONAL NEW DRUG",2090775,CDM,450,RC,96375,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",49.91,20.37,,61.03,44.13,77.92,"1 through 10","percent of total billed charges","20.37% of total billed charges",138.43,56.5,,543.80,39.03,931.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","35% of total billed charges",168.32,68.7,,13.42,13.42,13.42,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,80,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,220.5,
"IV PUSH INITIAL",2090774,CDM,450,RC,96374,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",60.09,20.37,,49.46,49.46,49.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",166.68,56.5,,140.50,49.77,419.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,108.28,59.34,157.22,"1 through 10","percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,47.10,47.10,47.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,101,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",60.09,265.5,
"IV THERAPEUTIC ADDITIONAL HR",2090766,CDM,450,RC,96366,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",41.76,20.37,,33.40,33.40,33.40,"1 through 10","percent of total billed charges","20.37% of total billed charges",115.83,56.5,,103.76,53.95,153.56,"1 through 10","percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,95.09,95.09,95.09,"1 through 10","percent of total billed charges","35% of total billed charges",140.84,68.7,,26.83,26.83,26.83,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,32.72,32.72,32.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,65.75,32.87,78.90,17,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,184.5,
"LAC CMPLX EA ADDTL 5 CMS",2013122,CDM,450,RC,13122,HCPCS,OUTPATIENT,,,815,652,,692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",285.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",559.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,733.5,
"LAC INTER 20.1 CM - 30.0 CM",2012036,CDM,450,RC,12036,HCPCS,OUTPATIENT,,,995,796,,845.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",202.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",895.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",348.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",683.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",577.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",202.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",845.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.68,895.5,
"LAC INTRM < 2.5 CM",2012031,CDM,450,RC,12031,HCPCS,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",199.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",116.11,513,
"LAC INTRM 12.6-20.0CM",2012035,CDM,450,RC,12035,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",274.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",159.9,706.5,
"LAC INTRM 2.6-7.5CM",2012032,CDM,450,RC,12032,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",133.42,589.5,
"LAC INTRM 2.6-7.5CM",2012042,CDM,450,RC,12042,HCPCS,OUTPATIENT,,,655,524,,556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",370.08,56.5,,903.21,903.21,903.21,"1 through 10","percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",370.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",229.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",449.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",379.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",133.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",133.42,589.5,
"LAC INTRM 5.1 CM - 7.5 CM",2012053,CDM,450,RC,12053,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",138.52,612,
"LAC INTRM 7.6-12.5CM",2012034,CDM,450,RC,12034,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",138.52,612,
"LAC INTRM HAND/FEET <2.5 OR LESS",2012041,CDM,450,RC,12041,HCPCS,OUTPATIENT,,,630,504,,535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",432.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",365.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",128.33,567,
"LAC REPAIR <2.5CM",2012000,CDM,450,RC,12001,HCPCS,OUTPATIENT,,,615,492,,522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",347.48,56.5,,1469.68,1049.29,1697.23,"1 through 10","percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",347.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",553.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",215.25,35,,91.00,91.00,91.00,"1 through 10","percent of total billed charges","35% of total billed charges",422.51,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",356.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",125.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",522.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.28,553.5,
"LAC REPAIR SIMPLE 12.6 CM TO 20.0 CM",2012016,CDM,450,RC,12016,HCPCS,OUTPATIENT,,,995,796,,845.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",202.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",562.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",895.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",348.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",683.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",577.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",202.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",845.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",202.68,895.5,
"LAC REPAIR TENDON/ MUSCLE FOREARM",2025270,CDM,450,RC,12001,HCPCS,OUTPATIENT,,,1610,1288,,1368.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",327.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",909.65,56.5,,1469.68,1049.29,1697.23,"1 through 10","percent of total billed charges","50.56% of total billed charges",909.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",909.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",909.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1449,90,,,,,0,"percent of total billed charges","90% of total billed charges",563.5,35,,91.00,91.00,91.00,"1 through 10","percent of total billed charges","35% of total billed charges",1106.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",933.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",327.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1368.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,1449,
"LAC RPR CMPLX <2.5 CM",2013131,CDM,450,RC,13131,HCPCS,OUTPATIENT,,,870,696,,739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",491.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",783,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",597.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",504.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",177.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",739.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",177.22,783,
"LAC RPR CMPLX 2.6-7.5 CM",2013121,CDM,450,RC,13121,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.31,805.5,
"LAC RPR CMPLX 2.6-7.5 CM",2013132,CDM,450,RC,13132,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.25,35,,448.00,203.91,692.08,"1 through 10","percent of total billed charges","35% of total billed charges",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,436.12,436.12,436.12,"1 through 10","fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.31,805.5,
"LAC SIMPLE  2.6-7.5CM",2012002,CDM,450,RC,12002,HCPCS,OUTPATIENT,,,685,548,,582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",139.53,20.37,,111.59,111.59,111.59,"1 through 10","percent of total billed charges","20.37% of total billed charges",387.03,56.5,,1415.47,1246.32,1809.24,"1 through 10","percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",387.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",616.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",239.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",470.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",397.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",139.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",582.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",139.53,616.5,
"LAC SIMPLE < 2.5",2012001,CDM,450,RC,,,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",142.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",199.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",116.11,513,
"LAC SIMPLE >30 CM",2012007,CDM,450,RC,12007,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.51,855,
"LAC SIMPLE 12.6-20.0CM",2012005,CDM,450,RC,12005,HCPCS,OUTPATIENT,,,815,652,,692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",285.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",559.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",472.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.02,733.5,
"LAC SIMPLE 20.1-30CM",2012006,CDM,450,RC,12006,HCPCS,OUTPATIENT,,,1020,816,,867,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",576.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",918,90,,,,,0,"percent of total billed charges","90% of total billed charges",357,35,,,,,0,"percent of total billed charges","35% of total billed charges",700.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",591.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",207.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",867,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",207.77,918,
"LAC SIMPLE 7.6-12.5CM",2012004,CDM,450,RC,12004,HCPCS,OUTPATIENT,,,725,580,,616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.63,56.5,,685.38,685.38,685.38,"1 through 10","percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",409.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",652.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",253.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",498.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",420.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",147.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",616.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",147.68,652.5,
"LEVEL I EMERGENCY ROOM",2099281,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50,,,57.01,45.50,58.35,"1 through 10","case rate","pays based on per visit rate",350,100,,190.00,59.93,364.40,"1 through 10","percent of total billed charges","100% of total billed charges",350,100,,,,,0,"percent of total billed charges","100% of total billed charges",350,100,,,,,0,"percent of total billed charges","100% of total billed charges",350,100,,,,,0,"percent of total billed charges","100% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,55.88,55.88,55.88,"1 through 10","percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,65.60,57.82,73.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50,350,
"LEVEL II EMERGENCY ROOM",2099282,CDM,450,RC,99282,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",187.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,157.75,157.75,157.75,"1 through 10","percent of total billed charges","20.37% of total billed charges",1000,100,,723.00,75.02,885.00,"1 through 10","percent of total billed charges","100% of total billed charges",1000,100,,,,,0,"percent of total billed charges","100% of total billed charges",1000,100,,,,,0,"percent of total billed charges","100% of total billed charges",1000,100,,,,,0,"percent of total billed charges","100% of total billed charges",146.77,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,78.32,78.32,78.32,"1 through 10","percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,159.65,159.65,159.65,"1 through 10","percent of total billed charges","20.37% of total billed charges",143.9,100,,112.82,112.82,112.82,16,"fee schedule","100% of CMS OPPS rate",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.51,1000,
"LEVEL III EMERGENCY ROOM",2099283,CDM,450,RC,99283,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.1,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,55.30,40.13,167.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",1200,100,,800.19,176.54,910.90,37,"percent of total billed charges","100% of total billed charges",1200,100,,,,,0,"percent of total billed charges","100% of total billed charges",1200,100,,,,,0,"percent of total billed charges","100% of total billed charges",1200,100,,,,,0,"percent of total billed charges","100% of total billed charges",256.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,185.54,185.54,185.54,"1 through 10","percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",226.45,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,191.58,73.07,191.58,20,"percent of total billed charges","20.37% of total billed charges",251.62,100,,197.27,197.27,197.27,77,"fee schedule","100% of CMS OPPS rate",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",226.45,1200,
"LEVEL IV EMERGENCY ROOM",2099284,CDM,450,RC,99284,HCPCS,OUTPATIENT,,,1400,1120,,1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",503.04,130,,,,,0,"fee schedule","130% of CMS OPPS rate",285.18,20.37,,228.06,186.43,233.36,"1 through 10","percent of total billed charges","20.37% of total billed charges",1400,100,,660.75,88.64,916.92,38,"percent of total billed charges","100% of total billed charges",1400,100,,,,,0,"percent of total billed charges","100% of total billed charges",1400,100,,,,,0,"percent of total billed charges","100% of total billed charges",1400,100,,,,,0,"percent of total billed charges","100% of total billed charges",394.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1260,90,,,,,0,"percent of total billed charges","90% of total billed charges",490,35,,216.47,216.47,216.47,"1 through 10","percent of total billed charges","35% of total billed charges",961.8,68.7,,688.66,524.70,852.61,"1 through 10","percent of total billed charges","68.7% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.25,90,,,,,0,"fee schedule","90% of CMS OPPS rate",812,58,,,,,0,"percent of total billed charges","58% of total billed charges",285.18,20.37,,223.51,76.52,223.51,15,"percent of total billed charges","20.37% of total billed charges",386.95,100,,303.37,299.38,303.37,159,"fee schedule","100% of CMS OPPS rate",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",386.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.18,1400,
"LEVEL V EMERGENCY ROOM",2099285,CDM,450,RC,99285,HCPCS,OUTPATIENT,,,1840,1472,,1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",724.29,130,,,,,0,"fee schedule","130% of CMS OPPS rate",374.81,20.37,,265.54,238.18,292.89,"1 through 10","percent of total billed charges","20.37% of total billed charges",1840,100,,853.54,396.17,1066.92,39,"percent of total billed charges","100% of total billed charges",1840,100,,,,,0,"percent of total billed charges","100% of total billed charges",1840,100,,,,,0,"percent of total billed charges","100% of total billed charges",1840,100,,,,,0,"percent of total billed charges","100% of total billed charges",568.29,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1656,90,,,,,0,"percent of total billed charges","90% of total billed charges",644,35,,293.76,293.76,293.76,"1 through 10","percent of total billed charges","35% of total billed charges",1264.08,68.7,,717.60,717.60,717.60,"1 through 10","percent of total billed charges","68.7% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",501.43,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1067.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",374.81,20.37,,293.76,250.67,293.76,19,"percent of total billed charges","20.37% of total billed charges",557.14,100,,436.81,436.81,1886.38,262,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1564,85,,,,,0,"percent of total billed charges","85% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",374.81,1840,
"LEVEL VI CRITICAL CARE",2099291,CDM,450,RC,99291,HCPCS,OUTPATIENT,,,2280,1824,,1938,85,,,,,0,"percent of total billed charges","85% of total billed charges",765.71,100,,,,,0,"fee schedule","100% of CMS OPPS rate",765.71,100,,,,,0,"fee schedule","100% of CMS OPPS rate",765.71,100,,,,,0,"fee schedule","100% of CMS OPPS rate",995.42,130,,,,,0,"fee schedule","130% of CMS OPPS rate",464.44,20.37,,359.67,359.67,359.67,"1 through 10","percent of total billed charges","20.37% of total billed charges",2280,100,,,,,0,"percent of total billed charges","100% of total billed charges",2280,100,,,,,0,"percent of total billed charges","100% of total billed charges",2280,100,,,,,0,"percent of total billed charges","100% of total billed charges",2280,100,,,,,0,"percent of total billed charges","100% of total billed charges",781.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2052,90,,,,,0,"percent of total billed charges","90% of total billed charges",798,35,,,,,0,"percent of total billed charges","35% of total billed charges",1566.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",765.71,100,,,,,0,"fee schedule","100% of CMS OPPS rate",689.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1322.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",464.44,20.37,,364.01,364.01,364.01,"1 through 10","percent of total billed charges","20.37% of total billed charges",765.71,100,,600.31,600.31,600.31,"1 through 10","fee schedule","100% of CMS OPPS rate",765.71,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1938,85,,,,,0,"percent of total billed charges","85% of total billed charges",765.71,100,,,,,0,"fee schedule","100% of CMS OPPS rate",464.44,2280,
"LUMBAR PUNCTURE",2062270,CDM,450,RC,62270,HCPCS,OUTPATIENT,,,785,628,,667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",443.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",706.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",274.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",539.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",455.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",159.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",667.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",159.9,818.11,
"MOD SED OTHER PHYS/QHP EA",2099157,CDM,450,RC,99157,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"MOD SED SAME PHYS/QHP < 5 YRS",2099155,CDM,450,RC,99155,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"MOD SED SAME PHYS/QHP < 5YRS",2099151,CDM,450,RC,99151,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",300,25,,,,,0,"percent of total billed charges","25% of total billed charges",300,25,,,,,0,"percent of total billed charges","25% of total billed charges",300,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",244.44,20.37,,195.48,195.48,195.48,"1 through 10","percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",244.44,1080,
"MOD SED SAME PHYS/QHP 5/> YRS",2099156,CDM,450,RC,99156,HCPCS,OUTPATIENT,,,1250,1000,,1062.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",254.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125,90,,,,,0,"percent of total billed charges","90% of total billed charges",437.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",858.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125,90,,,,,0,"percent of total billed charges","90% of total billed charges",725,58,,,,,0,"percent of total billed charges","58% of total billed charges",254.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1062.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",254.63,1125,
"MOD SED SAME PHYS/QHP 5/>YRS",2099152,CDM,450,RC,99152,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,31.55,31.55,31.55,"1 through 10","percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"MOD SED SAME PHYS/QHP EA",2099153,CDM,450,RC,99153,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,43.39,43.39,43.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"N BLOCK INJ INTERCOST SNG",2064420,CDM,450,RC,64420,HCPCS,OUTPATIENT,,,1985,1588,,1687.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",404.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1121.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1786.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",694.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1363.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1151.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",404.34,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1687.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",404.34,1786.5,
"N BLOCK INJ PLANTAR DIGIT",2064455,CDM,450,RC,64455,HCPCS,OUTPATIENT,,,945,756,,803.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",192.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",533.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",533.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",533.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",533.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",850.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",330.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",649.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",548.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",192.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",803.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",192.5,850.5,
"NAIL DECOMPRESSION",2011740,CDM,450,RC,11740,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",51.94,20.37,,10.38,10.38,10.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",51.94,229.5,
"NAIL REMOVAL",2011750,CDM,450,RC,11750,HCPCS,OUTPATIENT,,,1025,820,,871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",579.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",922.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",358.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",704.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",594.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",208.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",871.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",208.79,922.5,
"NAIL REMOVAL SIMPLE",2011730,CDM,450,RC,11730,HCPCS,OUTPATIENT,,,645,516,,548.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",131.39,20.37,,52.54,52.54,52.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",364.43,56.5,,1134.02,876.10,1391.94,"1 through 10","percent of total billed charges","50.56% of total billed charges",364.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",364.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",364.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",580.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",225.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",443.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",374.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",131.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",548.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.39,580.5,
"NASOGASTRIC TUBE PLACEMEN",2043752,CDM,450,RC,43752,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,471.41,
"NERVE BLK INJ TRIGEMINAL",2064400,CDM,450,RC,64400,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165,729,
"NERVE BLOCK OTHER PERIPHE",2064450,CDM,450,RC,64450,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",818.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,131.95,131.95,131.95,"1 through 10","percent of total billed charges","20.37% of total billed charges",457.65,56.5,,817.66,446.89,1188.43,"1 through 10","percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",641.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,129.32,129.32,129.32,"1 through 10","percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",566.38,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",629.32,100,,493.38,493.38,493.38,"1 through 10","fee schedule","100% of CMS OPPS rate",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",629.32,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165,818.11,
"NJX AA&/STRD GR OCPL NRV",2064405,CDM,450,RC,64405,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",203.7,900,
"NON-ROUNTINE BL DRAW 3/> YRS",2036410,CDM,450,RC,36410,HCPCS,OUTPATIENT,,,1250,1000,,1062.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",254.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",706.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125,90,,,,,0,"percent of total billed charges","90% of total billed charges",437.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",858.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1125,90,,,,,0,"percent of total billed charges","90% of total billed charges",725,58,,,,,0,"percent of total billed charges","58% of total billed charges",254.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1062.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",254.63,1125,
"NOSE BLEED CONTROL",2030901,CDM,450,RC,30901,HCPCS,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",322.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",199.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",116.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,513,
"OBSTETRICAL CARE",2059409,CDM,450,RC,59409,HCPCS,OUTPATIENT,,,9000,7200,,7650,85,,,,,0,"percent of total billed charges","85% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",2250,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1833.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",8100,90,,,,,0,"percent of total billed charges","90% of total billed charges",3150,35,,,,,0,"percent of total billed charges","35% of total billed charges",6183,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8100,90,,,,,0,"percent of total billed charges","90% of total billed charges",5220,58,,,,,0,"percent of total billed charges","58% of total billed charges",1833.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7650,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1833.3,8100,
"OPEN CHEST HEART MASSAGE",2032160,CDM,450,RC,32160,HCPCS,OUTPATIENT,,,9675,7740,,8223.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1970.8,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8707.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3386.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",6646.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",5611.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1970.8,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",8223.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",9675,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",1970.8,9675,
"OROGRASTRIC TUBE PLACEMEN",2043753,CDM,450,RC,43752,HCPCS,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",73.33,471.41,
PARACENTESIS,2049080,CDM,450,RC,,,OUTPATIENT,,,865,692,,735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",216.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",488.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",302.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",594.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",778.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",501.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",176.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",735.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",176.2,778.5,
"PERICARDIOCENTESIS W/IMAGING",2033016,CDM,450,RC,33016,HCPCS,OUTPATIENT,,,4575,3660,,3888.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1143.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1143.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1143.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",931.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4117.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1601.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3143.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4117.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2653.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",931.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3888.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",931.93,4117.5,
"PERITONEAL LAVAGE",2049084,CDM,450,RC,49084,HCPCS,OUTPATIENT,,,3200,2560,,2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1808,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2880,90,,,,,0,"percent of total billed charges","90% of total billed charges",1120,35,,,,,0,"percent of total billed charges","35% of total billed charges",2198.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1856,58,,,,,0,"percent of total billed charges","58% of total billed charges",651.84,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2720,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",651.84,2880,
"PLACE CATHETER IN VEIN",2036011,CDM,450,RC,36011,HCPCS,OUTPATIENT,,,2100,1680,,1785,85,,,,,0,"percent of total billed charges","85% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",525,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1186.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1186.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1186.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1186.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1890,90,,,,,0,"percent of total billed charges","90% of total billed charges",735,35,,,,,0,"percent of total billed charges","35% of total billed charges",1442.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1890,90,,,,,0,"percent of total billed charges","90% of total billed charges",1218,58,,,,,0,"percent of total billed charges","58% of total billed charges",427.77,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1785,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.77,1890,
"PREPUTIAL STRETCHING",2054450,CDM,450,RC,54450,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,675,
"PRP I/HERN INIT REDUC > 5YR",2049505,CDM,450,RC,49505,HCPCS,OUTPATIENT,,,14000,11200,,11900,85,,,,,0,"percent of total billed charges","85% of total billed charges",3500,25,,,,,0,"percent of total billed charges","25% of total billed charges",3500,25,,,,,0,"percent of total billed charges","25% of total billed charges",3500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2851.8,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,629.45,629.45,629.45,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",12600,90,,,,,0,"percent of total billed charges","90% of total billed charges",4900,35,,,,,0,"percent of total billed charges","35% of total billed charges",9618,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",12600,90,,,,,0,"percent of total billed charges","90% of total billed charges",8120,58,,,,,0,"percent of total billed charges","58% of total billed charges",2851.8,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",11900,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,12600,
"REM FB CONEAL W SLIT LAMP",2065222,CDM,450,RC,65222,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",88.61,391.5,
"REM FB EXT EYE",2065220,CDM,450,RC,65220,HCPCS,OUTPATIENT,,,1155,924,,981.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",235.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",652.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",652.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",652.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",652.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1039.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",404.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",793.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",669.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",235.27,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",981.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",235.27,1039.5,
"REMOVAL EMBEDDED FOREIGN BODY",2041805,CDM,450,RC,,,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",312.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",92.68,409.5,
"REMOVAL FOREIGN BODY FM EXTERNAL AUDITOR",2069200,CDM,450,RC,69200,HCPCS,OUTPATIENT,,,375,300,,318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",76.39,20.37,,59.16,59.16,59.16,"1 through 10","percent of total billed charges","20.37% of total billed charges",211.88,56.5,,1060.00,1032.00,1120.80,"1 through 10","percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",211.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",337.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",131.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",257.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",217.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",76.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",318.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.39,337.5,
"REMOVAL OF FOOT FOREIGN BODY",2028192,CDM,450,RC,28192,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,2718.30,2718.30,2718.30,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"REMOVAL OF FOOT FOREIGN BODY",2028193,CDM,450,RC,28193,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"REMOVAL OF FOREIGN BODY PELVIS OR HIP",2027086,CDM,450,RC,27086,HCPCS,OUTPATIENT,,,3840,3072,,3264,85,,,,,0,"percent of total billed charges","85% of total billed charges",960,25,,,,,0,"percent of total billed charges","25% of total billed charges",960,25,,,,,0,"percent of total billed charges","25% of total billed charges",960,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",782.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3456,90,,,,,0,"percent of total billed charges","90% of total billed charges",1344,35,,,,,0,"percent of total billed charges","35% of total billed charges",2638.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3456,90,,,,,0,"percent of total billed charges","90% of total billed charges",2227.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",782.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3264,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",782.21,3456,
"REMOVAL OF HEMORRHOID CLOT",2046320,CDM,450,RC,46320,HCPCS,OUTPATIENT,,,3300,2640,,2805,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",672.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1864.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2970,90,,,,,0,"percent of total billed charges","90% of total billed charges",1155,35,,,,,0,"percent of total billed charges","35% of total billed charges",2267.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1914,58,,,,,0,"percent of total billed charges","58% of total billed charges",672.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2805,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",672.21,2970,
"REMOVAL OF INGROWN TOENAIL",2011765,CDM,450,RC,11765,HCPCS,OUTPATIENT,,,735,588,,624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",415.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",661.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",257.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",504.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",426.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",149.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",624.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",149.72,661.5,
"REMOVAL REVISION OF CAST",2029700,CDM,450,RC,29700,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",313.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",246.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",241.34,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,697.5,
"REMOVAL SUTR&STAPL XREQ ANES",2015854,CDM,450,RC,15854,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"REMOVAL SUTR/STAPL XREQ ANES",2015853,CDM,450,RC,15853,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"REMOVE EMBEDDED FB EYELID",2067938,CDM,450,RC,67938,HCPCS,OUTPATIENT,,,1285,1028,,1092.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",353.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",261.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",726.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",277.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1156.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",449.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",882.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.47,90,,,,,0,"fee schedule","90% of CMS OPPS rate",745.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",261.75,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1092.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",271.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.47,1156.5,
"REMOVE HIP FOREIGN BODY",2027087,CDM,450,RC,27087,HCPCS,OUTPATIENT,,,9250,7400,,7862.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1884.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",8325,90,,,,,0,"percent of total billed charges","90% of total billed charges",3237.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6354.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",8325,90,,,,,0,"percent of total billed charges","90% of total billed charges",5365,58,,,,,0,"percent of total billed charges","58% of total billed charges",1884.23,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",7862.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1884.23,8325,
"REMOVE INPACTED EAR WAX UNI",2069209,CDM,450,RC,69209,HCPCS,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,292.5,
"REMOVE NAIL PLATE ADD-ON",2011732,CDM,450,RC,11732,HCPCS,OUTPATIENT,,,1525,1220,,1296.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",381.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",381.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",381.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",310.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",861.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",861.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",861.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",861.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1372.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",533.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1047.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1372.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",884.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",310.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1296.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",310.64,1372.5,
"REMOVE PHARYNX FOREIGN BODY",2042809,CDM,450,RC,42809,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
"REMOVE SHOULDER FB",2023330,CDM,450,RC,23330,HCPCS,OUTPATIENT,,,4500,3600,,3825,85,,,,,0,"percent of total billed charges","85% of total billed charges",1125,25,,,,,0,"percent of total billed charges","25% of total billed charges",1125,25,,,,,0,"percent of total billed charges","25% of total billed charges",1125,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",916.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4050,90,,,,,0,"percent of total billed charges","90% of total billed charges",1575,35,,,,,0,"percent of total billed charges","35% of total billed charges",3091.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4050,90,,,,,0,"percent of total billed charges","90% of total billed charges",2610,58,,,,,0,"percent of total billed charges","58% of total billed charges",916.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3825,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",916.65,4050,
"REMOVE SHOULDER FB DEEP",2023333,CDM,450,RC,23333,HCPCS,OUTPATIENT,,,8125,6500,,6906.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2031.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2031.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2031.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1655.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",7312.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2843.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",5581.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7312.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4712.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1655.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6906.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1655.06,7312.5,
"REPAIR BLOOD VESSEL DIRECT LOW EXT",2035226,CDM,450,RC,35226,HCPCS,OUTPATIENT,,,4265,3412,,3625.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",868.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3838.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1492.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2930.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2473.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",868.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3625.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,3838.5,
"REPAIR COMPLEX 2.6CM-7.5CM",2013152,CDM,450,RC,13152,HCPCS,OUTPATIENT,,,2050,1640,,1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1845,90,,,,,0,"percent of total billed charges","90% of total billed charges",717.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1408.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1189,58,,,,,0,"percent of total billed charges","58% of total billed charges",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",417.59,1845,
"REPAIR COMPLEX E/N/E/L 1.1-2.5 CM",2013151,CDM,450,RC,13151,HCPCS,OUTPATIENT,,,2050,1640,,1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1158.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1845,90,,,,,0,"percent of total billed charges","90% of total billed charges",717.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1408.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1189,58,,,,,0,"percent of total billed charges","58% of total billed charges",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",417.59,1845,
"REPAIR HAND TENDON",2026410,CDM,450,RC,26410,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"REPAIR LACERATION <2.5 CM MOUTH",2041250,CDM,450,RC,41250,HCPCS,OUTPATIENT,,,890,712,,756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",502.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",801,90,,,,,0,"percent of total billed charges","90% of total billed charges",311.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",611.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",516.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",181.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",756.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",181.29,801,
"REPAIR LACERATION TONGUE MOUTH OVER 2.6",2041252,CDM,450,RC,41252,HCPCS,OUTPATIENT,,,2135,1708,,1814.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",434.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1206.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1206.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1206.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1206.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1921.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",747.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1466.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1238.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",434.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1814.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,1921.5,
"REPAIR NAIL BED",2011760,CDM,450,RC,11760,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",723.13,130,,,,,0,"fee schedule","130% of CMS OPPS rate",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",567.39,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",500.63,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",556.26,100,,,,,0,"fee schedule","100% of CMS OPPS rate",56.02,723.13,
"REPAIR OF HEART WOUND",2033300,CDM,450,RC,33300,HCPCS,OUTPATIENT,,,24250,19400,,20612.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",4939.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",21825,90,,,,,0,"percent of total billed charges","90% of total billed charges",8487.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",16659.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",14065,58,,,,,0,"percent of total billed charges","58% of total billed charges",4939.73,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",20612.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",24250,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",2000,24250,
"REPAIR POSTOPERATIVE HEMORRHAGE/EXT",2035860,CDM,450,RC,,,OUTPATIENT,,,905,724,,769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",226.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",621.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",524.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.35,814.5,
"REPAIR TONGUE LACERATION",2041251,CDM,450,RC,41251,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"REPLACE G/C TUBE PERC",2049450,CDM,450,RC,49450,HCPCS,OUTPATIENT,,,3405,2724,,2894.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",693.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1923.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1923.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1923.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1923.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3064.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1191.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2339.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1974.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",693.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2894.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",693.6,3064.5,
"REPLACE TRACEOTOMY TUBE",2031502,CDM,450,RC,31502,HCPCS,OUTPATIENT,,,795,636,,675.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",161.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",449.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",449.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",449.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",449.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",715.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",278.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",546.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",461.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",161.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",675.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",161.94,715.5,
"RMVL FB UPPER ARM/ELBW DEEP",2024201,CDM,450,RC,24201,HCPCS,OUTPATIENT,,,8125,6500,,6906.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2031.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2031.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2031.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1655.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",7312.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2843.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",5581.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",7312.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4712.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1655.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6906.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1655.06,7312.5,
"RMVL FB UPPER ARM/ELBW SUBQ",2024200,CDM,450,RC,24200,HCPCS,OUTPATIENT,,,4650,3720,,3952.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1162.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1162.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1162.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",947.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4185,90,,,,,0,"percent of total billed charges","90% of total billed charges",1627.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3194.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4185,90,,,,,0,"percent of total billed charges","90% of total billed charges",2697,58,,,,,0,"percent of total billed charges","58% of total billed charges",947.21,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3952.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",947.21,4185,
"RPLC GTUBE NO REVJ TRC",2043762,CDM,450,RC,43762,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,173.26,173.26,173.26,"1 through 10","fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.59,630,
"RPR F/E/E/N/L/M>30.0CM",2012018,CDM,450,RC,12018,HCPCS,OUTPATIENT,,,575,460,,488.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",117.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",324.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",517.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",201.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",395.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",333.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",117.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",488.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,517.5,
"RPR FE/E/EN/L/M 20.1-30.0CM",2012017,CDM,450,RC,12017,HCPCS,OUTPATIENT,,,1150,920,,977.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",234.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",649.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",649.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",649.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",649.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1035,90,,,,,0,"percent of total billed charges","90% of total billed charges",402.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",790.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",667,58,,,,,0,"percent of total billed charges","58% of total billed charges",234.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",977.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.06,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.26,1035,
"SB BLOOD ADMINISTRATION",2036430,CDM,450,RC,36430,HCPCS,OUTPATIENT,,,1765,1412,,1500.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",516.46,130,,,,,0,"fee schedule","130% of CMS OPPS rate",359.53,20.37,,287.51,287.51,287.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",997.23,56.5,,1092.93,522.14,1663.72,"1 through 10","percent of total billed charges","50.56% of total billed charges",997.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",997.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",997.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",405.22,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1588.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",617.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1212.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.55,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1023.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",359.53,20.37,,281.79,281.79,281.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",397.28,100,,311.46,311.46,311.46,"1 through 10","fee schedule","100% of CMS OPPS rate",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1500.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.55,1588.5,
"SHAVING OF EPIDERMAL/DERMAL LESION",2011305,CDM,450,RC,11305,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",312.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",92.68,409.5,
"SPLINT APP ARM LONG",2029105,CDM,450,RC,29105,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",143.38,100,,112.42,112.42,112.42,"1 through 10","fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"SPLINT APP FINGER",2029130,CDM,450,RC,29130,HCPCS,OUTPATIENT,,,320,256,,272,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",65.18,20.37,,35.30,23.16,47.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",180.8,56.5,,1004.68,778.99,1230.37,"1 through 10","percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",180.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",288,90,,,,,0,"percent of total billed charges","90% of total billed charges",112,35,,49.47,49.47,49.47,"1 through 10","percent of total billed charges","35% of total billed charges",219.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",185.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",65.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",272,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",65.18,288,
"SPLINT APP LEG",2029505,CDM,450,RC,29505,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,66.79,66.79,66.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"SPLINT APP LOWER LEG",2029515,CDM,450,RC,29515,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,14.45,14.45,14.45,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,276.34,276.34,276.34,"1 through 10","percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,140.53,118.04,163.01,"1 through 10","fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"SPLINT APPLICATION ARM SHORT",2029125,CDM,450,RC,29125,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,722.57,722.57,722.57,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"STRAPPING ANKLE & OR FOOT",2029540,CDM,450,RC,29540,HCPCS,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",88.61,20.37,,71.89,71.07,72.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",245.78,56.5,,819.55,63.52,1889.48,"1 through 10","percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,69.44,69.44,69.44,"1 through 10","percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,112.42,112.42,112.42,"1 through 10","fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",88.61,391.5,
"STRAPPING ELBOW OR WRIST",2029260,CDM,450,RC,29260,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",51.94,20.37,,41.54,41.54,41.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",144.08,56.5,,1806.42,1806.42,1806.42,"1 through 10","percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,229.5,
"STRAPPING HAND OR FINGER",2029280,CDM,450,RC,29280,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",51.94,20.37,,41.54,41.54,41.54,"1 through 10","percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,229.5,
"STRAPPING OF CHEST",2029200,CDM,450,RC,29200,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",186.4,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",146.25,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.05,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",143.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"STRAPPING OF HIP",2029520,CDM,450,RC,29520,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"STRAPPING OF KNEE",2029530,CDM,450,RC,29530,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",51.94,20.37,,40.23,40.23,40.23,"1 through 10","percent of total billed charges","20.37% of total billed charges",144.08,56.5,,1806.42,1806.42,1806.42,"1 through 10","percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",51.94,229.5,
"STRAPPING OF SHOULDER",2029240,CDM,450,RC,29240,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,722.57,722.57,722.57,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"STRAPPING OF TOES",2029550,CDM,450,RC,29550,HCPCS,OUTPATIENT,,,255,204,,216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",144.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",229.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",175.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",147.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",51.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",216.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,229.5,
"THER/PROPH/DIAG INJ IA",2096373,CDM,450,RC,96373,HCPCS,OUTPATIENT,,,600,480,,510,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",339,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",339,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",339,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",339,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",540,90,,,,,0,"percent of total billed charges","90% of total billed charges",210,35,,,,,0,"percent of total billed charges","35% of total billed charges",412.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",348,58,,,,,0,"percent of total billed charges","58% of total billed charges",122.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",510,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",122.22,540,
"THER/PROPH/DIAG INJ SC/IM",2096372,CDM,450,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"THORACENTESIS DRAIN CHEST",2032001,CDM,450,RC,,,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",329,35,,,,,0,"percent of total billed charges","35% of total billed charges",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,846,
"THORACENTESIS INSERT TUBE",2032002,CDM,450,RC,32421,HCPCS,OUTPATIENT,,,940,752,,799,85,,,,,0,"percent of total billed charges","85% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",235,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",531.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",329,35,,,,,0,"percent of total billed charges","35% of total billed charges",645.78,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",846,90,,,,,0,"percent of total billed charges","90% of total billed charges",545.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",191.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",799,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",191.48,846,
"THROMBOLYTIC THERAPY STROKE",2037195,CDM,450,RC,37195,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",391.84,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",307.44,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.27,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
TRACHEOSTOMY,3031603,CDM,450,RC,31603,HCPCS,OUTPATIENT,,,3120,2496,,2652,85,,,,,0,"percent of total billed charges","85% of total billed charges",780,25,,,,,0,"percent of total billed charges","25% of total billed charges",780,25,,,,,0,"percent of total billed charges","25% of total billed charges",780,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",635.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1762.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2808,90,,,,,0,"percent of total billed charges","90% of total billed charges",1092,35,,,,,0,"percent of total billed charges","35% of total billed charges",2143.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2808,90,,,,,0,"percent of total billed charges","90% of total billed charges",1809.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",635.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2652,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",635.54,2808,
"TRAUMA RESPONS W/HOP CRITI",2000390,CDM,450,RC,G0390,HCPCS,OUTPATIENT,,,4000,3200,,3400,85,,,,,0,"percent of total billed charges","85% of total billed charges",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1563.14,130,,,,,0,"fee schedule","130% of CMS OPPS rate",814.8,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1226.46,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3600,90,,,,,0,"percent of total billed charges","90% of total billed charges",1400,35,,,,,0,"percent of total billed charges","35% of total billed charges",2748,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1082.17,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2320,58,,,,,0,"percent of total billed charges","58% of total billed charges",814.8,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3400,85,,,,,0,"percent of total billed charges","85% of total billed charges",1202.41,100,,,,,0,"fee schedule","100% of CMS OPPS rate",814.8,3600,
"TREAT BIG TOE FRACTURE",2028495,CDM,450,RC,28495,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT FINGER FRACTURE EACH",2026720,CDM,450,RC,26720,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,903.21,903.21,903.21,"1 through 10","percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,170.90,170.90,170.90,"1 through 10","fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",137.5,607.5,
"TREAT FINGER FRACTURE EACH",2026750,CDM,450,RC,26750,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",137.5,607.5,
"TREAT FRACTURE OF RADIUS",2025505,CDM,450,RC,25505,HCPCS,OUTPATIENT,,,4860,3888,,4131,85,,,,,0,"percent of total billed charges","85% of total billed charges",1215,25,,,,,0,"percent of total billed charges","25% of total billed charges",1215,25,,,,,0,"percent of total billed charges","25% of total billed charges",1215,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",989.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4374,90,,,,,0,"percent of total billed charges","90% of total billed charges",1701,35,,,,,0,"percent of total billed charges","35% of total billed charges",3338.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4374,90,,,,,0,"percent of total billed charges","90% of total billed charges",2818.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",989.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4131,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",989.98,4374,
"TREAT FRACTURE RADIUS/ULNA",2025600,CDM,450,RC,25600,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,208.20,208.20,208.20,"1 through 10","percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,107.76,107.76,107.76,"1 through 10","percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,170.90,170.90,170.90,"1 through 10","fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",137.5,607.5,
"TREAT HIP DISLOCATION",2027256,CDM,450,RC,27256,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT HIP DISLOCATION",2027257,CDM,450,RC,27257,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"TREAT HIP DISLOCATION",2027266,CDM,450,RC,27266,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREAT HUMERUS FRACTURE",2024505,CDM,450,RC,24505,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"TREAT HUMERUS FRACTURE",2024530,CDM,450,RC,24530,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,105.88,105.88,105.88,"1 through 10","percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT HUMERUS FRACTURE",2024535,CDM,450,RC,24535,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREAT HUMERUS FRACTURE",2024560,CDM,450,RC,24560,HCPCS,OUTPATIENT,,,1000,800,,850,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",565,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",900,90,,,,,0,"percent of total billed charges","90% of total billed charges",350,35,,,,,0,"percent of total billed charges","35% of total billed charges",687,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",580,58,,,,,0,"percent of total billed charges","58% of total billed charges",203.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",850,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,900,
"TREAT KNEE DISLOCATION",2027552,CDM,450,RC,27552,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREAT KNUCKLE DISLOCATION",2026700,CDM,450,RC,26700,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,4140,
"TREAT KNUCKLE DISLOCATION",2026705,CDM,450,RC,26705,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREAT LOWER LEG FRACTURE",2027824,CDM,450,RC,27824,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT METATARSAL FRACTURE",2028470,CDM,450,RC,28470,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT METATARSAL FRACTURE",2028475,CDM,450,RC,28475,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT RADIUS FRACTURE",2024650,CDM,450,RC,24650,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,85.45,85.45,85.45,"1 through 10","fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT THIGH FRACTURE",2027500,CDM,450,RC,27500,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT THIGH FRACTURE",2027501,CDM,450,RC,27501,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT THIGH FRACTURE",2027502,CDM,450,RC,27502,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREAT THIGH FRACTURE",2027503,CDM,450,RC,27503,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREAT THIGH FRACTURE",2027508,CDM,450,RC,27508,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT TOE DISLOCATION",2028630,CDM,450,RC,28630,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT TOE DISLOCATION",2028635,CDM,450,RC,28635,HCPCS,OUTPATIENT,,,6000,4800,,5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",1500,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",2100,35,,,,,0,"percent of total billed charges","35% of total billed charges",4122,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5400,90,,,,,0,"percent of total billed charges","90% of total billed charges",3480,58,,,,,0,"percent of total billed charges","58% of total billed charges",1222.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5100,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1222.2,5400,
"TREAT TOE DISLOCATION",2028660,CDM,450,RC,28660,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREAT WRIST BONE FRACTURE",2025650,CDM,450,RC,25650,HCPCS,OUTPATIENT,,,675,540,,573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",381.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",607.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",236.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",463.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",391.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",137.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",573.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",137.5,607.5,
"TREATMENT OF ANKLE FRACTURE",2027786,CDM,450,RC,27786,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,388.10,388.10,388.10,"1 through 10","percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREATMENT OF ANKLE FRACTURE",2027788,CDM,450,RC,27788,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREATMENT OF ANKLE FRACTURE",2027808,CDM,450,RC,27808,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREATMENT OF ANKLE FRACTURE",2027816,CDM,450,RC,27816,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,215.77,215.77,215.77,"1 through 10","percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREATMENT OF FIBULA FRACTURE",2027780,CDM,450,RC,27780,HCPCS,OUTPATIENT,,,630,504,,535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",355.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",567,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",432.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",365.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",128.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",535.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",128.33,567,
"TREATMENT OF FIBULA FRACTURE",2027781,CDM,450,RC,27781,HCPCS,OUTPATIENT,,,4600,3680,,3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",1150,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",1610,35,,,,,0,"percent of total billed charges","35% of total billed charges",3160.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4140,90,,,,,0,"percent of total billed charges","90% of total billed charges",2668,58,,,,,0,"percent of total billed charges","58% of total billed charges",937.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3910,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",937.02,4140,
"TREATMENT OF PENIS LESION",2054220,CDM,450,RC,54220,HCPCS,OUTPATIENT,,,750,600,,637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",287.31,130,,,,,0,"fee schedule","130% of CMS OPPS rate",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",423.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",225.43,102,,,,,0,"fee schedule","102% of CMS OPPS rate",675,90,,,,,0,"percent of total billed charges","90% of total billed charges",262.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",515.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",198.9,90,,,,,0,"fee schedule","90% of CMS OPPS rate",435,58,,,,,0,"percent of total billed charges","58% of total billed charges",152.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",637.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",221.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.78,675,
"TREATMENT OF TIBIA FRACTURE",2027750,CDM,450,RC,27750,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREATMENT OF TOE FRACTURE",2028515,CDM,450,RC,28515,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",641.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,1021.5,
"TREATULNAR FRACTURE",2024670,CDM,450,RC,24670,HCPCS,OUTPATIENT,,,650,520,,552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",283.38,130,,,,,0,"fee schedule","130% of CMS OPPS rate",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",367.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",222.34,102,,,,,0,"fee schedule","102% of CMS OPPS rate",585,90,,,,,0,"percent of total billed charges","90% of total billed charges",227.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",446.55,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",196.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",377,58,,,,,0,"percent of total billed charges","58% of total billed charges",132.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",552.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",217.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",132.41,585,
"TREATULNAR FRACTURE",2024675,CDM,450,RC,24675,HCPCS,OUTPATIENT,,,4860,3888,,4131,85,,,,,0,"percent of total billed charges","85% of total billed charges",1215,25,,,,,0,"percent of total billed charges","25% of total billed charges",1215,25,,,,,0,"percent of total billed charges","25% of total billed charges",1215,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",989.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4374,90,,,,,0,"percent of total billed charges","90% of total billed charges",1701,35,,,,,0,"percent of total billed charges","35% of total billed charges",3338.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4374,90,,,,,0,"percent of total billed charges","90% of total billed charges",2818.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",989.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4131,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",989.98,4374,
TRIAGE,2000001,CDM,450,RC,99281,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50,,,57.01,45.50,58.35,"1 through 10","case rate","pays based on per visit rate",140,100,,190.00,59.93,364.40,"1 through 10","percent of total billed charges","100% of total billed charges",140,100,,,,,0,"percent of total billed charges","100% of total billed charges",140,100,,,,,0,"percent of total billed charges","100% of total billed charges",140,100,,,,,0,"percent of total billed charges","100% of total billed charges",81.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,55.88,55.88,55.88,"1 through 10","percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,65.60,57.82,73.38,"1 through 10","percent of total billed charges","20.37% of total billed charges",80.01,100,,62.73,62.73,62.73,11,"fee schedule","100% of CMS OPPS rate",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",80.01,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.52,140,
"TRIGGER POINTS INJ",2020551,CDM,450,RC,20551,HCPCS,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",361.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,,,,0,"percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",130.37,576,
"UNLISTED PROCEDURE EXTERNAL EAR",2069399,CDM,450,RC,69399,HCPCS,OUTPATIENT,,,775,620,,658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",274.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",437.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",215.24,102,,,,,0,"fee schedule","102% of CMS OPPS rate",697.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",271.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",532.43,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.91,90,,,,,0,"fee schedule","90% of CMS OPPS rate",449.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",157.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",658.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",211.02,100,,,,,0,"fee schedule","100% of CMS OPPS rate",157.87,697.5,
"US URINE CAPACITY MEASURE",2051798,CDM,450,RC,51798,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,315,
"VASC EMBOLIZE/OCCLUDE BLEED",2037244,CDM,450,RC,37244,HCPCS,OUTPATIENT,,,32000,25600,,27200,85,,,,,0,"percent of total billed charges","85% of total billed charges",8000,25,,,,,0,"percent of total billed charges","25% of total billed charges",8000,25,,,,,0,"percent of total billed charges","25% of total billed charges",8000,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6518.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",28800,90,,,,,0,"percent of total billed charges","90% of total billed charges",11200,35,,,,,0,"percent of total billed charges","35% of total billed charges",21984,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",28800,90,,,,,0,"percent of total billed charges","90% of total billed charges",18560,58,,,,,0,"percent of total billed charges","58% of total billed charges",6518.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27200,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,28800,
"VENIPUNCTURE CUTDOWN < 1 YR",2036420,CDM,450,RC,36420,HCPCS,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",91.67,405,
"VENIPUNCTURE CUTDOWN 1 YR/>",2036425,CDM,450,RC,36425,HCPCS,OUTPATIENT,,,1100,880,,935,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",224.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",385,35,,,,,0,"percent of total billed charges","35% of total billed charges",755.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",638,58,,,,,0,"percent of total billed charges","58% of total billed charges",224.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",935,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",224.07,990,
"ATTENDANCE AT DELIVERY",5599436,CDM,460,RC,99464,HCPCS,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,34.71,34.71,34.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",124.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"CP AIRWAY INHALATION TREATMENT",5894640,CDM,460,RC,94640,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",154.81,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",154.81,684,
"CP AIRWAY INHALATION TREATMENT SUB",5894641,CDM,460,RC,94640,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,94.97,72.45,110.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,64.16,64.16,64.16,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,106.97,82.54,106.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,240.27,
"CP CARDIAC REHAB w/EKG MONITORING",5893798,CDM,460,RC,93798,HCPCS,OUTPATIENT,,,420,336,,357,85,,,,,0,"percent of total billed charges","85% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",148.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",85.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",237.3,56.5,,226.51,135.90,417.53,"1 through 10","percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",116.7,102,,,,,0,"fee schedule","102% of CMS OPPS rate",378,90,,,,,0,"percent of total billed charges","90% of total billed charges",147,35,,,,,0,"percent of total billed charges","35% of total billed charges",288.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",243.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",85.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",114.42,100,,179.40,89.70,179.40,"1 through 10","fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357,85,,,,,0,"percent of total billed charges","85% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",85.55,378,
"CP CARDIAC REHAB w/o EKG MONITORING",5893797,CDM,460,RC,93797,HCPCS,OUTPATIENT,,,420,336,,357,85,,,,,0,"percent of total billed charges","85% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",148.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",85.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",116.7,102,,,,,0,"fee schedule","102% of CMS OPPS rate",378,90,,,,,0,"percent of total billed charges","90% of total billed charges",147,35,,,,,0,"percent of total billed charges","35% of total billed charges",288.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",243.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",85.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357,85,,,,,0,"percent of total billed charges","85% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",85.55,378,
"CP CARDIAC REHABILITATION",5800422,CDM,460,RC,G0422,HCPCS,OUTPATIENT,,,400,320,,340,85,,,,,0,"percent of total billed charges","85% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",148.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",226,56.5,,213.16,134.49,376.00,"1 through 10","percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",226,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",116.7,102,,,,,0,"fee schedule","102% of CMS OPPS rate",360,90,,,,,0,"percent of total billed charges","90% of total billed charges",140,35,,,,,0,"percent of total billed charges","35% of total billed charges",274.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",232,58,,,,,0,"percent of total billed charges","58% of total billed charges",81.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",114.42,100,,179.40,89.70,179.40,"1 through 10","fee schedule","100% of CMS OPPS rate",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",340,85,,,,,0,"percent of total billed charges","85% of total billed charges",114.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",81.48,360,
"CP CARDIOPULM EXERCISE TESTING",5894621,CDM,460,RC,94621,HCPCS,OUTPATIENT,,,1120,896,,952,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",228.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1008,90,,,,,0,"percent of total billed charges","90% of total billed charges",392,35,,,,,0,"percent of total billed charges","35% of total billed charges",769.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",649.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",228.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",952,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",228.14,1008,
"CP CHEST WALL MANIPULATION",5894667,CDM,460,RC,94667,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",94.72,20.37,,20.51,20.51,20.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",94.72,418.5,
"CP CHEST WALL MANIPULATION SUB",5894668,CDM,460,RC,94668,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",94.72,418.5,
"CP EVALUATE PT USE OF INHALER",5894664,CDM,460,RC,94664,HCPCS,OUTPATIENT,,,766,612.8,,651.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",156.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",689.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",268.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",526.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",444.28,58,,,,,0,"percent of total billed charges","58% of total billed charges",156.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",651.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",156.03,689.4,
"CP EXERCISE TST BRNCSPSM W/ECG",5894617,CDM,460,RC,94617,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",94.72,418.5,
"CP EXHALED AIR ANALYSIS O2/CO2",5894681,CDM,460,RC,94681,HCPCS,OUTPATIENT,,,1120,896,,952,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",228.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",632.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1008,90,,,,,0,"percent of total billed charges","90% of total billed charges",392,35,,,,,0,"percent of total billed charges","35% of total billed charges",769.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",649.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",228.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",952,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",228.14,1008,
"CP HLTH & BHVR ED INDIVIDUAL",5896158,CDM,460,RC,,,OUTPATIENT,,,285,228,,242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",71.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",161.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",99.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",195.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",256.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",165.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",242.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.05,256.5,
"CP HLTH & BHVR EDUCATION CLASS",5896164,CDM,460,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"CP MEASURE BLOOD OXYGEN LEVEL",5894761,CDM,460,RC,94761,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"CP MEASURE BLOOD OXYGEN LEVEL CONT",5894762,CDM,460,RC,94762,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119.16,526.5,
"CP MECHANICAL CHEST WALL OSCILL",5894669,CDM,460,RC,94669,HCPCS,OUTPATIENT,,,766,612.8,,651.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",156.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",432.79,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",689.4,90,,,,,0,"percent of total billed charges","90% of total billed charges",268.1,35,,,,,0,"percent of total billed charges","35% of total billed charges",526.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",444.28,58,,,,,0,"percent of total billed charges","58% of total billed charges",156.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",651.1,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",156.03,689.4,
"CP OTH RESP PROC INDIV",5800238,CDM,460,RC,G0238,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.92,130,,,,,0,"fee schedule","130% of CMS OPPS rate",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,4.45,4.45,4.45,"1 through 10","percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,90,,,,,0,"fee schedule","90% of CMS OPPS rate",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.25,100,,139.58,41.88,139.58,"1 through 10","fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,108,
"CP PROF SVC OP PULM RHB W CONTINUOUS OX",5894626,CDM,460,RC,94625,HCPCS,OUTPATIENT,,,202,161.6,,171.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",41.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",181.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",70.7,35,,,,,0,"percent of total billed charges","35% of total billed charges",138.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",117.16,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",171.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.15,181.8,
"CP PROF SVC OP PULM RHB WO CONTINUOUS OX",5894625,CDM,460,RC,94625,HCPCS,OUTPATIENT,,,202,161.6,,171.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",41.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",114.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",181.8,90,,,,,0,"percent of total billed charges","90% of total billed charges",70.7,35,,,,,0,"percent of total billed charges","35% of total billed charges",138.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",117.16,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",171.7,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.15,181.8,
"CP PULMONARY STRESS TESTING SIMPLE 6 MIN",5894618,CDM,460,RC,94618,HCPCS,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",94.72,418.5,
"CP THERAPEUTIC PROCD STRG ENDUR",5800237,CDM,460,RC,G0237,HCPCS,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.92,130,,,,,0,"fee schedule","130% of CMS OPPS rate",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",67.8,56.5,,4.45,4.45,4.45,"1 through 10","percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",67.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",22.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,90,,,,,0,"fee schedule","90% of CMS OPPS rate",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.25,100,,139.58,41.88,139.58,"1 through 10","fee schedule","100% of CMS OPPS rate",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.02,108,
"CP UNLISTED PULMONARY SVC/PX",5894799,CDM,460,RC,94799,HCPCS,OUTPATIENT,,,585,468,,497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.83,130,,,,,0,"fee schedule","130% of CMS OPPS rate",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",330.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",526.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",204.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",401.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",339.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",119.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119.16,526.5,
"DIFFUSION STUDIES",5594350,CDM,460,RC,94729,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"LUNG VOLUMES",5500003,CDM,460,RC,94727,HCPCS,OUTPATIENT,,,425,340,,361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.83,130,,,,,0,"fee schedule","130% of CMS OPPS rate",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",240.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",382.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",148.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",291.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",246.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",86.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",361.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.57,382.5,
"PEAK FLOW",5594360,CDM,460,RC,94726,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,28.74,28.74,28.74,"1 through 10","percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",36.67,367.87,
"PFT B & A",5594060,CDM,460,RC,94060,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",138.52,612,
"PFT SCREEN (SPIROMETRY)",5500001,CDM,460,RC,94010,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.83,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
"POS AIRWAY PRESSURE CPAP",5594660,CDM,460,RC,94660,HCPCS,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",240.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",188.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.34,738,
"PULMONARY STRESS TEST SIMPLE 6 MIN WALK",5594620,CDM,460,RC,94618,HCPCS,OUTPATIENT,,,605,484,,514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",544.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",415.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",350.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,544.5,
"PULSE OXIMETRY",5594760,CDM,460,RC,94760,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"HEARING SCREENING/NEWBORN",500001,CDM,479,RC,92587,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",23.43,367.87,
"HEARING SCREENING/NEWBORN",501157,CDM,479,RC,92585,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"CARDIOPULMONARY RESUSCITA",5592950,CDM,480,RC,92950,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,270.27,270.27,270.27,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,221.85,221.85,221.85,"1 through 10","fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",578,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",138.52,986.63,
"EXTERNAL PACEMAKER",2092953,CDM,480,RC,92953,HCPCS,OUTPATIENT,,,1135,908,,964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",773.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",606.54,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1021.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",397.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",779.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",535.19,90,,,,,0,"fee schedule","90% of CMS OPPS rate",658.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",231.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",594.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",231.2,1021.5,
"STRESS TEST (TREADMILL)",5693017,CDM,482,RC,93017,HCPCS,OUTPATIENT,,,1305,1044,,1109.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",265.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",288.64,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1174.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",456.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",896.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",756.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",265.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1109.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.68,1174.5,
"ECHO COMPLETE W/ DOPPLER/COLOR FLOW",5793306,CDM,483,RC,93306,HCPCS,OUTPATIENT,,,2910,2328,,2473.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",647.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",592.77,20.37,,365.87,365.87,365.87,"1 through 10","percent of total billed charges","20.37% of total billed charges",862.48,100,,1289.48,234.50,1611.85,20,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",508.22,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2619,90,,,,,0,"percent of total billed charges","90% of total billed charges",1018.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1999.17,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",448.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1687.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",592.77,20.37,,70.95,70.95,307.13,"1 through 10","percent of total billed charges","20.37% of total billed charges",498.25,100,,390.64,390.64,390.64,93,"fee schedule","100% of CMS OPPS rate",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2473.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",448.42,2619,
"ECHO LIMITED STUDY",5793308,CDM,483,RC,93308,HCPCS,OUTPATIENT,,,480,384,,408,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",432,90,,,,,0,"percent of total billed charges","90% of total billed charges",168,35,,,,,0,"percent of total billed charges","35% of total billed charges",329.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",278.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",97.78,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",408,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",97.78,986.63,
"ECHO STRESS TTE ONLY",5793350,CDM,483,RC,93350,HCPCS,OUTPATIENT,,,2030,1624,,1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",647.74,130,,,,,0,"fee schedule","130% of CMS OPPS rate",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",508.22,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",710.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1394.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",448.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1177.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",498.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",413.51,1827,
ELECTROCAUTERY,2017000,CDM,490,RC,17000,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.59,986.63,
"EXCISION BENIGN LESION .6-1.0 CM",1011401,CDM,490,RC,11401,HCPCS,OUTPATIENT,,,2050,1640,,1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1845,90,,,,,0,"percent of total billed charges","90% of total billed charges",717.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1408.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1189,58,,,,,0,"percent of total billed charges","58% of total billed charges",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,1845,
"EXCISION BENIGN LESION <.5 cm",1011400,CDM,490,RC,11400,HCPCS,OUTPATIENT,,,2050,1640,,1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1845,90,,,,,0,"percent of total billed charges","90% of total billed charges",717.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1408.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1189,58,,,,,0,"percent of total billed charges","58% of total billed charges",417.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1742.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",417.59,1845,
"EXCISION BENIGN LESION INCL MARGINS",1011402,CDM,490,RC,11402,HCPCS,OUTPATIENT,,,1880,1504,,1598,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",382.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,334.69,248.23,421.14,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1692,90,,,,,0,"percent of total billed charges","90% of total billed charges",658,35,,,,,0,"percent of total billed charges","35% of total billed charges",1291.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1090.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",382.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1598,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.96,1692,
"EXCISION SKIN LESION",1011422,CDM,490,RC,,,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,463.5,
"EXCISION SKIN LESION/BIOPSY OF SKIN",1011100,CDM,490,RC,,,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",128.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",290.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",104.91,463.5,
"EXCISION SKIN TAGS",1011200,CDM,490,RC,11200,HCPCS,OUTPATIENT,,,515,412,,437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,896.03,896.03,896.03,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",463.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",180.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",353.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",298.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",104.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",437.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",104.91,986.63,
"REMOVE SKIN TAGS",1011201,CDM,490,RC,11201,HCPCS,OUTPATIENT,,,260,208,,221,85,,,,,0,"percent of total billed charges","85% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",65,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",91,35,,,,,0,"percent of total billed charges","35% of total billed charges",178.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",234,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",52.96,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",221,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",52.96,986.63,
"IM INJECTION FEE",3090772,CDM,510,RC,96372,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",175.15,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,279,
"OP CLINIC PROCEDURE ROOM",2000009,CDM,510,RC,99202,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,35.04,35.04,35.04,"1 through 10","percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"THERAPEUTIC INJECTION",1596374,CDM,510,RC,96374,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",60.09,20.37,,49.46,49.46,49.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",166.68,56.5,,140.50,49.77,419.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,108.28,59.34,157.22,"1 through 10","percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,47.10,47.10,47.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,101,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",60.09,265.5,
"AMBULANCE ALS",2000427,CDM,540,RC,A0427,HCPCS,OUTPATIENT,,,950,760,,807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",237.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",536.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",332.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",652.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",855,90,,,,,0,"percent of total billed charges","90% of total billed charges",551,58,,,,,0,"percent of total billed charges","58% of total billed charges",193.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",807.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",193.52,855,
"AMBULANCE GROUND MILEAGE",2000425,CDM,540,RC,A0425,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MRA ABDOMEN",4474185,CDM,610,RC,74185,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1069.43,4725,
"MRA BRAIN W/WO CONTRAST",4470546,CDM,610,RC,70546,HCPCS,OUTPATIENT,,,5875,4700,,4993.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1196.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3319.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3319.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3319.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3301.75,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5287.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2056.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",4036.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3407.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1196.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4993.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5287.5,
"MRA CHEST",4471555,CDM,610,RC,71555,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1069.43,4725,
"MRA LOWER EXT  W/O CONTRAST",4408913,CDM,610,RC,73725,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1312.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1069.43,4725,
"MRA LOWER EXT W/O & W/CONTRAST",4408914,CDM,610,RC,73725,HCPCS,OUTPATIENT,,,6250,5000,,5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1562.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3531.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3531.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3531.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3512.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",2187.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4293.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5625,90,,,,,0,"percent of total billed charges","90% of total billed charges",3625,58,,,,,0,"percent of total billed charges","58% of total billed charges",1273.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5312.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1273.13,5625,
"MRA NECK W/WO CONTRAST",4470549,CDM,610,RC,70549,HCPCS,OUTPATIENT,,,5875,4700,,4993.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1196.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3319.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3319.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3319.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3301.75,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5287.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2056.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",4036.13,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3407.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1196.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4993.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5287.5,
"MRA PITUITARY WITH CONTRA",4400010,CDM,610,RC,70544,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,328.86,328.86,328.86,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI ABD W/ CONTRAST",4474182,CDM,610,RC,74182,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI ABD W/WO CONTRAST",4474183,CDM,610,RC,74183,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,320.51,269.69,371.32,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,172.00,254.44,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI ABDOMEN W/O CONTRAST",4474181,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,334.65,334.65,334.65,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI BONE MARROW BLOOD",4476400,CDM,610,RC,77084,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI BREAST C BILATERAL",4477047,CDM,610,RC,77047,HCPCS,OUTPATIENT,,,3500,2800,,2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1977.5,56.5,,38.90,19.12,58.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1967,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",1225,35,,307.52,307.52,307.52,"1 through 10","percent of total billed charges","35% of total billed charges",2404.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2030,58,,,,,0,"percent of total billed charges","58% of total billed charges",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,126.33,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,3150,
"MRI BREAST C UNILATERAL",4477046,CDM,610,RC,77046,HCPCS,OUTPATIENT,,,3500,2800,,2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1967,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",1225,35,,,,,0,"percent of total billed charges","35% of total billed charges",2404.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2030,58,,,,,0,"percent of total billed charges","58% of total billed charges",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,3150,
"MRI BREAST W/WO CONTRAST W/CAD BILATERAL",4477049,CDM,610,RC,77049,HCPCS,OUTPATIENT,,,3500,2800,,2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",875,25,,,,,0,"percent of total billed charges","25% of total billed charges",875,25,,,,,0,"percent of total billed charges","25% of total billed charges",875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1977.5,56.5,,311.06,93.79,521.35,"1 through 10","percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1967,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",1225,35,,108.69,108.69,108.69,"1 through 10","percent of total billed charges","35% of total billed charges",2404.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",2030,58,,,,,0,"percent of total billed charges","58% of total billed charges",712.95,20.37,,48.24,48.24,48.24,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",712.95,3150,
"MRI BREAST W/WO CONTRAST W/CAD UNILATERA",4477048,CDM,610,RC,77048,HCPCS,OUTPATIENT,,,3500,2800,,2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",875,25,,,,,0,"percent of total billed charges","25% of total billed charges",875,25,,,,,0,"percent of total billed charges","25% of total billed charges",875,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1977.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1967,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",,,,,,,0,other,"not separately reimbursable",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",1225,35,,,,,0,"percent of total billed charges","35% of total billed charges",2404.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3150,90,,,,,0,"percent of total billed charges","90% of total billed charges",2030,58,,,,,0,"percent of total billed charges","58% of total billed charges",712.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2975,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",712.95,3150,
"MRI CHST/HILAR/MEDIASTINA",4471550,CDM,610,RC,71550,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI HIP LEFT WO CONT",4400018,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,828.19,828.19,828.19,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,215.87,65.42,367.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,838.18,838.18,838.18,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,33.45,172.21,19,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI HIP RIGHT WO CONT",4473721,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,828.19,828.19,828.19,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,215.87,65.42,367.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,838.18,838.18,838.18,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,33.45,172.21,19,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI LOWER EXT JNT W LT",4400021,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",933.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",732.31,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.15,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.15,4725,
"MRI LOWER EXT JNT W RT",4473722,CDM,610,RC,73722,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",933.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",732.31,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.15,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.15,4725,
"MRI LOWER EXT JNT W/WO LT",4400022,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,7025,5620,,5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3948.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6322.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2458.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4826.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4074.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6322.5,
"MRI LOWER EXT JNT W/WO RT",4473723,CDM,610,RC,73723,HCPCS,OUTPATIENT,,,7025,5620,,5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3948.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6322.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2458.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4826.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4074.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6322.5,
"MRI LOWER EXT JNT WO LT",4400023,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,828.19,828.19,828.19,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,215.87,65.42,367.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,838.18,838.18,838.18,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,33.45,172.21,19,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI LOWER EXT JNT WO RT",4400020,CDM,610,RC,73721,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,828.19,828.19,828.19,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,215.87,65.42,367.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,838.18,838.18,838.18,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,33.45,172.21,19,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI LOWER EXT NON JNT W LT",4400027,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI LOWER EXT NON JNT W RT",4473719,CDM,610,RC,73719,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI LOWER EXT NON JNT W/WO LT",4400017,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI LOWER EXT NON JNT W/WO RT",4473720,CDM,610,RC,73720,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI LOWER EXT NON JNT WO LT",4400016,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,60.39,48.53,243.63,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,342.36,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI LOWER EXT NON JNT WO RT",4473718,CDM,610,RC,73718,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,60.39,48.53,243.63,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,342.36,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI MRCP",4400026,CDM,610,RC,74181,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,334.65,334.65,334.65,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI MYOCARDIUM W/O CONTRA",4475552,CDM,610,RC,75557,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI NECK  W/0",4470547,CDM,610,RC,70540,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,427.20,427.20,427.20,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,92.06,27.94,156.18,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI ORBITS, FACE, AND/OR NECK W/WO",4470543,CDM,610,RC,70543,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,134.08,117.06,151.10,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,950.13,950.13,950.13,"1 through 10","percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,609.03,609.03,609.03,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI PELVIS W/O BONE",4400025,CDM,610,RC,72195,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI PELVIS W/WO CONTRAST",4472197,CDM,610,RC,72197,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,998.00,998.00,998.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI TMJ",4470336,CDM,610,RC,70336,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI UPPER EXT JOINT W/CONTRAST",4473222,CDM,610,RC,73222,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",933.33,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",732.31,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.15,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",717.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646.15,4725,
"MRI UPPER EXT NON-JT WITHOUT",4473218,CDM,610,RC,73220,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,447.60,161.95,733.25,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,254.44,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI UPPER EXT W/WO LEFT JNT",4400014,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,7025,5620,,5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3948.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6322.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2458.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4826.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4074.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6322.5,
"MRI UPPER EXT W/WO RIGHT JNT",4473223,CDM,610,RC,73223,HCPCS,OUTPATIENT,,,7025,5620,,5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3948.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6322.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2458.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4826.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4074.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6322.5,
"MRI UPPER EXT-JNT-RIGHT",4473221,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,234.30,41.19,368.31,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,41.37,41.37,41.37,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,166.59,172.21,17,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI UPPER EXTREMITY-LEFT WITH",4400015,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI UPPER EXTREMITY-RIGHT WITH",4473225,CDM,610,RC,73219,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI UPR EXT/NON JNT-LEFT W/O",4400012,CDM,610,RC,73218,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI UPR EXTRMTY JNT-LEFT",4400013,CDM,610,RC,73221,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,234.30,41.19,368.31,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,41.37,41.37,41.37,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,166.59,172.21,17,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI BRAIN W & W/O CONTRAST",4470553,CDM,611,RC,70553,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,105.39,105.39,105.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,235.55,127.25,251.18,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,1087.55,1087.55,1087.55,"1 through 10","percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,609.03,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI BRAIN W/CONTRAST",4470552,CDM,611,RC,70552,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI BRAIN W/O CONTRAST",4470551,CDM,611,RC,70551,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,855.21,855.21,855.21,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,209.67,67.40,334.65,12,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,811.75,811.75,811.75,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,97.70,52.29,143.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,15,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI FACIAL ORBITS FACE W/O",4400001,CDM,611,RC,70540,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,427.20,427.20,427.20,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,92.06,27.94,156.18,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI FACIAL ORBITS FACE W/WO",4470453,CDM,611,RC,70543,HCPCS,OUTPATIENT,,,7025,5620,,5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3969.13,56.5,,134.08,117.06,151.10,"1 through 10","percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3948.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6322.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2458.75,35,,950.13,950.13,950.13,"1 through 10","percent of total billed charges","35% of total billed charges",4826.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4074.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,609.03,609.03,609.03,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6322.5,
"MRI FACIAL ORBITS FACE WITH",4470542,CDM,611,RC,70542,HCPCS,OUTPATIENT,,,5690,4552,,4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3197.78,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",1991.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3909.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3300.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5121,
"MRI HEAD W/O(BRAIN)",4400002,CDM,611,RC,70551,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,855.21,855.21,855.21,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,209.67,67.40,334.65,12,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,811.75,811.75,811.75,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,97.70,52.29,143.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,15,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI NECK WITH",4400006,CDM,611,RC,70542,HCPCS,OUTPATIENT,,,5690,4552,,4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3197.78,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",1991.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3909.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3300.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5121,
"MRI ORBITS W/O",4470540,CDM,611,RC,70540,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,427.20,427.20,427.20,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,92.06,27.94,156.18,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI ORBITS WITH",4400007,CDM,611,RC,70542,HCPCS,OUTPATIENT,,,5690,4552,,4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3214.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3197.78,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",1991.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3909.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3300.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5121,
"MRI PITUITARY W & W/O",4400011,CDM,611,RC,70553,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,105.39,105.39,105.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,235.55,127.25,251.18,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,1087.55,1087.55,1087.55,"1 through 10","percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,609.03,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI PITUITARY W/O",4400009,CDM,611,RC,70551,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,855.21,855.21,855.21,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,209.67,67.40,334.65,12,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,811.75,811.75,811.75,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,97.70,52.29,143.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,15,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI UPPER RXT NON-JT W/WO",4473220,CDM,611,RC,73220,HCPCS,OUTPATIENT,,,7025,5620,,5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3969.13,56.5,,447.60,161.95,733.25,"1 through 10","percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3969.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3948.05,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6322.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2458.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4826.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4074.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1430.99,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,254.44,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5971.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,6322.5,
"MRI CERVICAL SPINE W/CON",4472142,CDM,612,RC,72142,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,254.44,254.44,254.44,"1 through 10","fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI CERVICAL SPINE W/O",4472141,CDM,612,RC,72141,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,118.57,43.94,244.63,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,838.18,838.18,838.18,"1 through 10","percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,68.06,46.36,89.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,384.90,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI CERVICAL SPINE W/WO",4400008,CDM,612,RC,72156,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,114.49,114.49,114.49,"1 through 10","percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,256.99,256.99,256.99,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI CERVIVAL SPINE W&W/O",4472156,CDM,612,RC,72156,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,114.49,114.49,114.49,"1 through 10","percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,256.99,256.99,256.99,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI LUMBAR SPINE WITH",4472149,CDM,612,RC,72149,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI LUMBAR SPINE WO CONTRA",4472148,CDM,612,RC,72148,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,427.61,427.61,427.61,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,68.55,52.73,256.06,12,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,438.28,41.06,837.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,122.94,172.21,28,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI LUMBAR W & W/O",4472158,CDM,612,RC,72158,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1251.74,20.37,,1001.00,1001.00,1001.00,"1 through 10","percent of total billed charges","20.37% of total billed charges",3471.93,56.5,,513.46,480.16,546.76,"1 through 10","percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3471.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",3453.49,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,5530.5,
"MRI PELVIC W/CONTRAST",4472196,CDM,612,RC,72196,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRI THORACIC SPINE W/O",4472146,CDM,612,RC,72146,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,62.37,51.31,211.66,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,278.56,172.21,384.90,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRI THORACIC W & W/O",4472157,CDM,612,RC,72157,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",421.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,852.21,852.21,852.21,"1 through 10","percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",331.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",324.52,100,,,,,0,"fee schedule","100% of CMS OPPS rate",292.07,4725,
"MRA HEAD W/OUT",4470544,CDM,615,RC,70544,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,328.86,328.86,328.86,"1 through 10","percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"MRA NECK W/O",4400003,CDM,615,RC,70547,HCPCS,OUTPATIENT,,,5250,4200,,4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2966.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2950.5,56.2,,,,,0,"percent of total billed charges","56.20% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4725,90,,,,,0,"percent of total billed charges","90% of total billed charges",1837.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3606.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3045,58,,,,,0,"percent of total billed charges","58% of total billed charges",1069.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4462.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,4725,
"AMPICILLIN INJ  2GM",2600073,CDM,636,RC,J0295,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.97,22.5,
"AMPICILLIN INJ 1GM",2601005,CDM,636,RC,J0290,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.85,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.89,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.85,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.85,22.5,
"ANCEF (CEFAZOLIN) INJ 1GM",2600036,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.97,120.37,,1.85,1.85,1.85,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,66.72,7.89,127.15,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.97,162,
"AZACTAM (AZTREONAM) 1GM VIAL",2600082,CDM,636,RC,,,OUTPATIENT,,,220,176,,187,85,,,,,0,"percent of total billed charges","85% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",55,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",77,35,,,,,0,"percent of total billed charges","35% of total billed charges",151.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",198,90,,,,,0,"percent of total billed charges","90% of total billed charges",127.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",44.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",187,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",44.81,198,
"FORTAZ (CEFTAZIDIME) INJ 1GM",2601171,CDM,636,RC,J0713,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.99,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.07,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.99,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.99,103.5,
"FORTAZ (CEFTAZIDIME) INJ 2GM",2601172,CDM,636,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"MAGNESIUM SULF 50% VIAL 5GM/10ML",2601357,CDM,636,RC,J3475,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.61,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.59,40.5,
"MAXIPIME (CEFEPIME) INJ 1GM",2605061,CDM,636,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MAXIPIME (CEFEPIME) INJ 2GM",2605056,CDM,636,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MEFOXIN INJ (CEFOXITIN) 1GM",2601037,CDM,636,RC,J0694,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.57,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.36,166.5,
"MEFOXIN INJ (CEFOXITIN) 2GM",2601038,CDM,636,RC,J0694,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.57,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.36,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.36,346.5,
"NF-INVanz Injection Powder for Solution",2668544,CDM,636,RC,J1335,HCPCS,OUTPATIENT,,,41.13,32.9,,34.96,85,,,,,0,"percent of total billed charges","85% of total billed charges",10.28,25,,,,,0,"percent of total billed charges","25% of total billed charges",10.28,25,,,,,0,"percent of total billed charges","25% of total billed charges",10.28,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",37.02,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",28.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.02,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.86,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.25,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34.96,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.28,37.02,
"PROTOPAM (PRALIDOXIME) INJ 1GM",2601382,CDM,636,RC,,,OUTPATIENT,,,475,380,,403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",118.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",166.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",326.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",427.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",275.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",96.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",403.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",96.76,427.5,
"ROCEPHIN INJ (CEFTRIAXONE NA) 1GM",2601060,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,120.37,,1.58,1.33,2.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,145.78,49.56,197.11,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.56,125.18,,1.99,1.99,1.99,"1 through 10","fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.54,120.37,,2.15,1.34,7.19,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,207,
"ROCEPHIN INJ (CEFTRIAXONE NA) 2GM",2601062,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,380,304,,323,85,,,,,0,"percent of total billed charges","85% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",95,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,120.37,,1.58,1.33,2.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,145.78,49.56,197.11,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.56,125.18,,1.99,1.99,1.99,"1 through 10","fee schedule","125.18% of GA fee schedule",261.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",342,90,,,,,0,"percent of total billed charges","90% of total billed charges",220.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.54,120.37,,2.15,1.34,7.19,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",323,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,342,
"TIMENTIN (TICARCILLIN/CLAV) VIAL 3.1GM",2605137,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"UNASYN (AMPICILLIN/SULBACTAM) INJ 1.5GM",2601052,CDM,636,RC,J0295,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.97,49.5,
"UNASYN (AMPICILLIN/SULBACTAM) INJ 3GM",2601053,CDM,636,RC,J0295,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.97,81,
"VANCOCIN (VANCOMYCIN) INJ 1GM",2601418,CDM,636,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"ZINACEF INJ 1.5GM",2601026,CDM,636,RC,J0697,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.37,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.27,36,
"ZOSYN 4.5GM VIAL",2600002,CDM,636,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"ZOSYN INJ 3.375GM",2601056,CDM,636,RC,J2543,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.37,120.37,,2.28,2.28,2.28,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,82.19,72.18,86.71,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.43,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.37,120.37,,3.73,3.73,3.73,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.37,153,
"ALPROSTADIL INJ 500MCG/ML",2610182,CDM,636,RC,J0270,HCPCS,OUTPATIENT,,,358.5,286.8,,304.73,85,,,,,0,"percent of total billed charges","85% of total billed charges",89.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",89.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",89.63,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",322.65,90,,,,,0,"percent of total billed charges","90% of total billed charges",125.48,35,,,,,0,"percent of total billed charges","35% of total billed charges",246.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",322.65,90,,,,,0,"percent of total billed charges","90% of total billed charges",207.93,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",304.73,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.03,322.65,
"ALPROSTADIL INJ 500MCG/ML",2610188,CDM,636,RC,J0270,HCPCS,OUTPATIENT,,,431.75,345.4,,366.99,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.94,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.94,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.94,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",388.58,90,,,,,0,"percent of total billed charges","90% of total billed charges",151.11,35,,,,,0,"percent of total billed charges","35% of total billed charges",296.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",388.58,90,,,,,0,"percent of total billed charges","90% of total billed charges",250.42,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.95,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",366.99,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.95,388.58,
"ENGERIX-B (HEPATITIS B VAC) INJ : 20MCG",2601021,CDM,636,RC,90744,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"FENTANYL CITRATE INJ 100MCG",2601165,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.06,125.18,,10.79,10.79,10.79,"1 through 10","fee schedule","125.18% of GA fee schedule",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,120.37,,53.70,53.70,53.70,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,72,
"FENTANYL CITRATE INJ 250MCG",2605072,CDM,636,RC,J3010,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.06,125.18,,10.79,10.79,10.79,"1 through 10","fee schedule","125.18% of GA fee schedule",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,120.37,,53.70,53.70,53.70,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,72,
"HEMABATE (CARBOPROST) 250MCG/1ML AMP",2600083,CDM,636,RC,,,OUTPATIENT,,,340,272,,289,85,,,,,0,"percent of total billed charges","85% of total billed charges",85,25,,,,,0,"percent of total billed charges","25% of total billed charges",85,25,,,,,0,"percent of total billed charges","25% of total billed charges",85,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",69.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,90,,,,,0,"percent of total billed charges","90% of total billed charges",119,35,,,,,0,"percent of total billed charges","35% of total billed charges",233.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",306,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",69.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",289,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",69.26,306,
"NEUPOGEN (FILGRASTIM) INJ 300MCG",2601391,CDM,636,RC,J1440,HCPCS,OUTPATIENT,,,1215,972,,1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",82.68,130,,,,,0,"fee schedule","130% of CMS OPPS rate",76.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",633.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",64.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1093.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",79.61,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",834.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",57.24,90,,,,,0,"fee schedule","90% of CMS OPPS rate",704.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",76.56,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1032.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",63.6,100,,,,,0,"fee schedule","100% of CMS OPPS rate",57.24,1093.5,
"NEUPOGEN (FILGRASTIM) INJ 480MCG",2601396,CDM,636,RC,J1442,HCPCS,OUTPATIENT,,,1925,1540,,1636.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1004.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1004.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1004.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1004.29,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",0.99,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1732.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.23,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1322.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.88,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1116.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.18,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1636.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.98,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.88,1732.5,
"NF-FENTANYL CITRATE INJ 50MCG",2601162,CDM,636,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"PULMICORT (BUDESONIDE) FLEXHALER 90MCG",2610141,CDM,636,RC,,,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,,,,0,"percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,576,
"SINCALIDE (KINEVAC) VIAL 5MCG",2602262,CDM,636,RC,J2805,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"VIT B-12 (CYANOCOBALAMIN) INJ 1MG",2601267,CDM,636,RC,J3420,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.53,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.53,40.5,
"CALCIUM GLUCONATE 10% VIAL 10ML",2600014,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"POTASSIUM CHLORIDE INJ 40MEQ/20ML",2602683,CDM,636,RC,J3480,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.13,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.12,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.12,40.5,
"SOD ACETATE INJ 2MEQ",2603077,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SOD BICARBONATE 4.2% INJ 5MEQ",2600062,CDM,636,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SOD CHLORIDE CONC 23.4% INJ  4MEQ",2602268,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ADENOCARD (ADENOSINE) INJ : 6MG",2601345,CDM,636,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"AMINOPHYLLINE 500MG/20ML VIAL",2601254,CDM,636,RC,J0280,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",6.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.22,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.22,153,
"AMPICILLIN INJ 125MG",2601003,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"AMPICILLIN INJ 250MG",2601002,CDM,636,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AMPICILLIN INJ 500MG",2601004,CDM,636,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ANCEF INJ : 500MG",2600030,CDM,636,RC,J0690,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.97,120.37,,1.85,1.85,1.85,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,66.72,7.89,127.15,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.01,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.97,31.5,
"ANECTINE (SUCCINYLCHOLINE) INJ : 200MG",2601257,CDM,636,RC,J0330,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,295.31,91.48,499.13,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"APRESOLINE (HYDRALAZINE HCL) INJ  20MG",2602515,CDM,636,RC,J0360,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,70.91,70.91,70.91,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.91,126,
"AQUAMEPHYTON (PHYTONADIONE) INJ 10MG",2601262,CDM,636,RC,J3430,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.66,94.5,
"AQUAMEPHYTON PED (PHYTONADIONE) INJ 1MG",2601261,CDM,636,RC,J3430,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.66,36,
"AREDIA (PAMIDRONATE) INJ : 90MG",2605020,CDM,636,RC,J2430,HCPCS,OUTPATIENT,,,4255,3404,,3616.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1063.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1063.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1063.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",2219.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2219.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2219.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2219.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",3829.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",2923.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3829.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2467.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.14,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3616.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.14,3829.5,
"ATIVAN (LORAZEPAM) INJ 2MG",2602100,CDM,636,RC,J2060,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,1.89,1.89,1.89,"1 through 10","percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"ATRACURIUM VIAL 50MG/5ML",2600004,CDM,636,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"ATROPINE SULFATE INJ 0.4MG",2600050,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,40.5,
"ATROPINE SULFATE INJ 1MG",2601266,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,40.5,
"ATROPINE SULFATE INJ 1MG/10ML SYRINGE",2603021,CDM,636,RC,J0461,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,40.5,
"AVELOX (MOXIFLOXACIN) IV 400MG",2605131,CDM,636,RC,J2280,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"BAMLANIVIMAB 700MG/20ML VIAL",2610123,CDM,636,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"BEBTELOVIMAB 175MG/2ML VIAL",2610152,CDM,636,RC,,,OUTPATIENT,,,0.01,0.01,,0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.01,0.01,
"BENADRYL (DIPHENHYDRAMINE HCL) INJ 50MG",2602530,CDM,636,RC,J1200,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.88,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,22.79,22.79,22.79,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.91,125.18,,0.74,0.74,0.74,"1 through 10","fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.88,120.37,,1.01,1.01,1.01,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.88,40.5,
"BENTYL (DICYCLOMINE HCL) INJ 20MG",2602534,CDM,636,RC,J0500,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",18.65,125.18,,16.67,16.67,16.67,"1 through 10","fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.94,103.5,
"BENTYL (DICYCLOMINE HCL) INJ 20MG",2610133,CDM,636,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"BRETHINE (TERBUTALINE SULF) INJ 1MG",2602535,CDM,636,RC,J3105,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.68,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.58,207,
"BREVIBLOC (ESMOLOL HCL) INJ 100MG",2601420,CDM,636,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"BRIDION (SUGAMMADEX) INJ 200MG",2610130,CDM,636,RC,,,OUTPATIENT,,,405,324,,344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",141.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",278.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,364.5,
"CALCIUM CL 10% INJ 1000MG",2600052,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CASIRIVIMAB/IMDEVIMAB 600MG/600MG VIAL",2610135,CDM,636,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"CELESTONE (BETAMETHASONE ACET/P) INJ:6MG",2601278,CDM,636,RC,J0702,HCPCS,OUTPATIENT,,,110,88,,93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",9.4,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",75.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.04,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.04,99,
"CLAFORAN (CEFOTAXIME NA) INJ : 500MG",2601001,CDM,636,RC,J0698,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.27,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.8,58.5,
"CLINDAMYCIN 300MG/2ML VIAL",2600011,CDM,636,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"COMPAZINE (PROCHLORPERAZINE) INJ 10MG",2606050,CDM,636,RC,J0780,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.69,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.55,49.5,
"COMPAZINE (PROCHLORPERAZINE) INJ 10MG",2610121,CDM,636,RC,J0780,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.69,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.55,22.5,
"CORDARONE INJ 150MG",2605048,CDM,636,RC,J0282,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CORTROSYN (COSYNTROPIN) INJ 0.25MG",2601422,CDM,636,RC,,,OUTPATIENT,,,640,512,,544,85,,,,,0,"percent of total billed charges","85% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",160,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",333.89,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",224,35,,,,,0,"percent of total billed charges","35% of total billed charges",439.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",576,90,,,,,0,"percent of total billed charges","90% of total billed charges",371.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",130.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",544,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.37,576,
"DAPTOMYCIN INJ 500MG VIAL",2610187,CDM,636,RC,J0878,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.05,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.05,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.05,45,
"DECADRON (DEXAMETHASONE) INJ 4MG",2602208,CDM,636,RC,J1100,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,120.37,,0.62,0.43,1.37,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,74.14,74.14,74.14,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.13,120.37,,0.94,0.62,2.68,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.13,49.5,
"DELESTROGEN (ESTRADIOL VAL) INJ : 20MG",2605166,CDM,636,RC,J1380,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"DEMADEX (TORSEMIDE) INJ 20MG",2601338,CDM,636,RC,J3265,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DEMEROL (MEPERIDINE HCL) INJ 100MG",2601153,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,53.92,53.92,53.92,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,72,
"DEMEROL (MEPERIDINE HCL) INJ 25MG",2601155,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,53.92,53.92,53.92,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,72,
"DEMEROL (MEPERIDINE HCL) INJ 50MG",2601152,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,53.92,53.92,53.92,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,72,
"DEPO-ESTRADIOL (ESTRADIOL CYP) INJ 5MG",2601293,CDM,636,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"DEPO-MEDROL (METHYLPREDNISOLONE) 40MG",2601394,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DEPO-PROVERA (MEDROXYPROGEST)INJ 150MG",2603046,CDM,636,RC,,,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",141.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,508.5,
"DHE-45 (DIHYDROERGOTAMINE) INJ : 1MG",2601305,CDM,636,RC,J1110,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",51.37,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.4,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.4,180,
"DIGIBIND (DIG IMMUNE FAB) INJ 38MG",2602235,CDM,636,RC,J1162,HCPCS,OUTPATIENT,,,4195,3356,,3565.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6590.97,130,,,,,0,"fee schedule","130% of CMS OPPS rate",854.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2188.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2188.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2188.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2188.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",5171.37,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3775.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1468.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2881.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4562.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2433.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",854.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3565.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5069.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",854.52,6590.97,
"DILANTIN (PHENYTOIN SOD) 100MG INJ",2602596,CDM,636,RC,J1165,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.57,22.5,
"DILANTIN (PHENYTOIN SOD) 250MG INJ",2602597,CDM,636,RC,J1165,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.59,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.57,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.57,40.5,
"DILAUDID (HYDROMORPHONE HCL) INJ 1MG",2601163,CDM,636,RC,J1171,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.09,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.09,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.09,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",0.11,120.37,,0.07,0.06,0.08,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,0.09,0.09,0.09,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.09,102,,,,,0,"fee schedule","102% of CMS OPPS rate",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.11,125.18,,0.10,0.10,0.10,"1 through 10","fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",0.09,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.08,90,,,,,0,"fee schedule","90% of CMS OPPS rate",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.11,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.09,100,,0.07,0.07,0.07,"1 through 10","fee schedule","100% of CMS OPPS rate",0.09,100,,,,,0,"fee schedule","100% of CMS OPPS rate",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.09,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.08,40.5,
"DILAUDID (HYDROMORPHONE HCL) INJ 2MG",2601161,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DRAMAMINE (DIMENHYDRINATE) INJ : 50MG",2601308,CDM,636,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"EPINEPHRINE INJ AMPULE 1MG",2601251,CDM,636,RC,J0169,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"EPINEPHRINE SYRINGE 1MG",2600055,CDM,636,RC,J0169,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ERYTHROCIN (ERYTHROMYCIN LAC) INJ 500MG",2600040,CDM,636,RC,J1364,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",74.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",77.79,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",74.8,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.5,77.79,
"FERAHEME (FERUMOXYTOL) INJ 510MG",2600192,CDM,636,RC,Q0138,HCPCS,OUTPATIENT,,,1945,1556,,1653.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.49,130,,,,,0,"fee schedule","130% of CMS OPPS rate",0.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1014.73,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1014.73,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1014.73,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1014.73,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",0.38,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1750.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1336.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.34,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1128.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1653.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.34,1750.5,
"FOLIC ACID INJ 1MG",2601253,CDM,636,RC,J3490,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"GARAMYCIN (GENTAMICIN SULF) INJ 20MG",2602260,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.97,40.5,
"GARAMYCIN (GENTAMICIN SULF) INJ 80MG",2602246,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.97,40.5,
"GEODON (ZIPRASIDONE) INJ 20MG/ML",2601318,CDM,636,RC,J3486,HCPCS,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.65,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.65,85.5,
"GLUCAGON INJ 1MG",2601316,CDM,636,RC,J1610,HCPCS,OUTPATIENT,,,570,456,,484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",239.43,130,,,,,0,"fee schedule","130% of CMS OPPS rate",221.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",187.86,102,,,,,0,"fee schedule","102% of CMS OPPS rate",513,90,,,,,0,"percent of total billed charges","90% of total billed charges",230.56,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",391.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165.76,90,,,,,0,"fee schedule","90% of CMS OPPS rate",330.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",221.7,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",484.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",184.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.01,513,
"HALDOL (HALOPERIDOL DECANOATE) INJ 100MG",2602649,CDM,636,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"HALDOL (HALOPERIDOL LACTATE) INJ 5MG",2601317,CDM,636,RC,J1630,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.46,120.37,,1.17,1.17,1.17,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.46,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.46,40.5,
"IMITREX (SUMATRIPTAN) INJ 6MG",2605116,CDM,636,RC,J3030,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.34,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",58.98,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.75,61.34,
"INDERAL (PROPRANOLOL) INJ 1MG/1ML",2600001,CDM,636,RC,J1800,HCPCS,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.19,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.72,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.72,54,
"INFED (IRON DEXTRAN) INJ 50MG/ML VIAL",2601325,CDM,636,RC,J1750,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",22.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",20.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17.73,102,,,,,0,"fee schedule","102% of CMS OPPS rate",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",15.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.94,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",15.65,243,
"INJECTAFER 750MG/15ML VIAL",2601330,CDM,636,RC,J1439,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.44,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,2713.76,1201.96,4225.56,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1.12,102,,,,,0,"fee schedule","102% of CMS OPPS rate",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.39,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.99,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.11,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.99,13.5,
"INTEGRILIN (EPTIFIBAT.) 0.75MG/1ML 100ML",2605030,CDM,636,RC,J1327,HCPCS,OUTPATIENT,,,2055,1644,,1746.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",513.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",513.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",513.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1072.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1072.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1072.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1072.11,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1849.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",719.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1411.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1849.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1191.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",418.6,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1746.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.6,1849.5,
"INTEGRILIN (EPTIFIBATIDE) INJ 20MG",2605029,CDM,636,RC,J1327,HCPCS,OUTPATIENT,,,660,528,,561,85,,,,,0,"percent of total billed charges","85% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",165,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",344.33,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",344.33,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",344.33,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",344.33,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",231,35,,,,,0,"percent of total billed charges","35% of total billed charges",453.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",594,90,,,,,0,"percent of total billed charges","90% of total billed charges",382.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",134.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",561,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",134.44,594,
"KENALOG-40 (TRIAMCINOLONE ACET) INJ 40MG",2602217,CDM,636,RC,J3301,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.13,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.08,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.08,153,
"KEPPRA (LEVETIRACETAM) INJ 500MG/5ML",2611012,CDM,636,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LANOXIN (DIGOXIN) INJ 0.5MG",2602686,CDM,636,RC,J1160,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.04,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.62,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.62,40.5,
"LASIX (FUROSEMIDE) INJ 100MG",2601344,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LASIX (FUROSEMIDE) INJ 20MG",2601343,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LASIX (FUROSEMIDE) INJ 40MG",2602689,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LEVAQUIN 250MG IV PREMIX",2602343,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,175.96,175.96,175.96,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,209.58,209.58,209.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"LEVAQUIN 500MG IV PREMIX",2605191,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",83.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,175.96,175.96,175.96,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",230.15,68.7,,209.58,209.58,209.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",68.24,301.5,
"LEVAQUIN 750MG IV PREMIX",2605193,CDM,636,RC,J1956,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",107.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,175.96,175.96,175.96,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",295.41,68.7,,209.58,209.58,209.58,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",87.59,387,
"LEXISCAN .4MG/5ML SYRINGE",2600157,CDM,636,RC,J2785,HCPCS,OUTPATIENT,,,1105,884,,939.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",276.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",276.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",276.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",576.49,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",576.49,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",576.49,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",576.49,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",994.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.77,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",759.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",994.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",640.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",939.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.59,994.5,
"LIDOCAINE 2% CARDIAC INJ 100MG",2600059,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LOVENOX (ENOXAPARIN) INJ 100MG",2605092,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,17.19,8.28,19.88,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"LOVENOX (ENOXAPARIN) INJ 120MG",2605178,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,17.19,8.28,19.88,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"LOVENOX (ENOXAPARIN) INJ 150MG",2601423,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",427.8,52.17,,17.19,8.28,19.88,"1 through 10","percent of total billed charges","52.17% of total billed charges",427.8,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",427.8,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",427.8,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,738,
"LOVENOX (ENOXAPARIN) INJ 30MG",2601411,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,17.19,8.28,19.88,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"LOVENOX (ENOXAPARIN) INJ 40MG",2601424,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,17.19,8.28,19.88,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LOVENOX (ENOXAPARIN) INJ 60MG",2603052,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,17.19,8.28,19.88,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"LOVENOX (ENOXAPARIN) INJ 80MG",2660000,CDM,636,RC,J1650,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,10.16,6.56,13.76,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,17.19,8.28,19.88,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,21.94,21.94,21.94,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"LUPRON DEPOT (LEUPROLIDE 3M) INJ: 22.5MG",2601277,CDM,636,RC,J1950,HCPCS,OUTPATIENT,,,11225,8980,,9541.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2166.81,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2006.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5856.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",5856.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",5856.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",5856.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1700.11,102,,,,,0,"fee schedule","102% of CMS OPPS rate",10102.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2086.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",7711.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1500.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",6510.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",2006.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9541.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1500.1,10102.5,
"MERREM (MEROPENEM) 1GM VIAL",2601063,CDM,636,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"MERREM (MEROPENEM) 500MG VIAL",2601064,CDM,636,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"METHERGIN (METHYLERGONAVINE) INJ 0.2MG",2601362,CDM,636,RC,J2210,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.31,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20,72,
"METHOTREXATE INJ 25MG/ML 2ML VIAL",2605134,CDM,636,RC,J9260,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.06,81,
"METHYLENE BLUE 0.5% INJ 10ML",2601361,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11.57,130,,,,,0,"fee schedule","130% of CMS OPPS rate",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.9,100,,50.76,35.54,65.98,"1 through 10","fee schedule","100% of CMS OPPS rate",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.01,49.5,
"MILRINONE INJ 10MG/10ML VIAL",2610189,CDM,636,RC,J2260,HCPCS,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.64,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.58,9,
"MILRINONE LACTATE INJ 10MG",2610183,CDM,636,RC,J2260,HCPCS,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.64,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.58,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.58,9,
"MORPHINE (DURAMORPH) 0.5MG/1ML 10ML AMP",2603013,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,67.5,
"MORPHINE (DURAMORPH) 1MG/1ML 10ML AMP",2600022,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,76.5,
"MORPHINE PCA 1MG/1ML INJ",2601202,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,126,
"MORPHINE SULF INJ 10MG",2602229,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,63,
"MORPHINE SULF INJ 2MG",2601166,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,63,
"MORPHINE SULF INJ 4MG",2601167,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,63,
"MORPHINE SULF INJ 5MG",2605125,CDM,636,RC,J2270,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,32.34,14.03,285.47,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,49.5,
"NARCAN (NALOXONE HCL) INJ 0.4MG",2601364,CDM,636,RC,J2312,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"NARCAN (NALOXONE) INJ 2MG/2ML SYRINGE",2610160,CDM,636,RC,J2312,HCPCS,OUTPATIENT,,,37.5,30,,31.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",9.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",9.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",9.38,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",33.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.13,35,,,,,0,"percent of total billed charges","35% of total billed charges",25.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",33.75,90,,,,,0,"percent of total billed charges","90% of total billed charges",21.75,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.88,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.64,33.75,
"NEO-SYNEPHINE 1% (PHENYLEPHRINE)INJ 10MG",2601365,CDM,636,RC,J2371,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,40.5,
"NF-DEMEROL (MEPERIDINE HCL) INJ : 75MG",2601154,CDM,636,RC,J2175,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.71,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",54.96,68.7,,53.92,53.92,53.92,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.38,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.38,72,
"NF-LUPRON DEPOT (LEUPROLIDE) INJ:11.25MG",2605099,CDM,636,RC,J1950,HCPCS,OUTPATIENT,,,12860,10288,,10931,85,,,,,0,"percent of total billed charges","85% of total billed charges",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2166.81,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2006.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6709.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6709.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6709.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6709.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1700.11,102,,,,,0,"fee schedule","102% of CMS OPPS rate",11574,90,,,,,0,"percent of total billed charges","90% of total billed charges",2086.48,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",8834.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1500.1,90,,,,,0,"fee schedule","90% of CMS OPPS rate",7458.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2006.3,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",10931,85,,,,,0,"percent of total billed charges","85% of total billed charges",1666.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1500.1,11574,
"NF-MIVACRON (MIVACURIUM) 20MG/10ML VIAL",2601360,CDM,636,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"NF-PREVACID (LANSOPRAZOLE) INJ : 30MG",2603053,CDM,636,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"NF-PROMETHAZINE (PHENERGAN) INJ 50MG",2602772,CDM,636,RC,J2550,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.3,120.37,,3.34,2.75,3.92,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.47,125.18,,3.21,3.21,3.21,"1 through 10","fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.3,120.37,,3.85,3.73,3.96,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.3,63,
"NORMODYNE (LABETALOL HCL) INJ 100MG",2602833,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NUBAIN (NALBUPHINE) INJ 10MG",2601168,CDM,636,RC,J2300,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.13,40.5,
"NUBAIN (NALBUPHINE) INJ 20MG",2605083,CDM,636,RC,J2300,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.29,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.13,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.13,31.5,
"PENTOTHAL (THIOPENTAL SOD) INJ 500MG",2601176,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PERSANTINE (DIPYRIDAMOLE) INJ PER 10MG",2605188,CDM,636,RC,J1245,HCPCS,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.84,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.66,130.5,
"PHENERGAN (PROMETHAZINE HCL) INJ 25MG",2601372,CDM,636,RC,J2550,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.3,120.37,,3.34,2.75,3.92,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.47,125.18,,3.21,3.21,3.21,"1 through 10","fee schedule","125.18% of GA fee schedule",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.3,120.37,,3.85,3.73,3.96,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.3,18,
"PHENOBARB (PHENOBARBITAL NA) INJ 130MG",2601177,CDM,636,RC,J2560,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.75,38.51,
"PHENOBARB (PHENOBARBITAL NA) INJ 65MG",2601179,CDM,636,RC,J2560,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.51,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.03,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.25,40.5,
"PHENTOLAMINE INJ 5MG",2610191,CDM,636,RC,J2760,HCPCS,OUTPATIENT,,,832.5,666,,707.63,85,,,,,0,"percent of total billed charges","85% of total billed charges",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",513.01,130,,,,,0,"fee schedule","130% of CMS OPPS rate",169.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",434.32,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",434.32,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",434.32,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",434.32,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",402.52,102,,,,,0,"fee schedule","102% of CMS OPPS rate",749.25,90,,,,,0,"percent of total billed charges","90% of total billed charges",291.38,35,,,,,0,"percent of total billed charges","35% of total billed charges",571.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",355.16,90,,,,,0,"fee schedule","90% of CMS OPPS rate",482.85,58,,,,,0,"percent of total billed charges","58% of total billed charges",169.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",707.63,85,,,,,0,"percent of total billed charges","85% of total billed charges",394.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",169.58,749.25,
"PREMARIN (ESTROGENS CONJ) INJ 25MG",2605084,CDM,636,RC,J1410,HCPCS,OUTPATIENT,,,365,292,,310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",497.78,130,,,,,0,"fee schedule","130% of CMS OPPS rate",460.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",390.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",328.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",479.33,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",250.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",344.61,90,,,,,0,"fee schedule","90% of CMS OPPS rate",211.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",460.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",310.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",382.91,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.7,497.78,
"PRIMAXIN 250MG IV VIAL",2600017,CDM,636,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"PROLIA (DENOSUMAB) INJ 60MG",2605095,CDM,636,RC,J0897,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.95,130,,,,,0,"fee schedule","130% of CMS OPPS rate",33.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,1292.24,277.19,1564.75,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",28.21,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.62,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.89,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",33.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.89,81,
"PROSTIGMINE (NEOSTIGMINE) INJ 10MG/10ML",2601380,CDM,636,RC,J2710,HCPCS,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.96,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.96,292.5,
"PROTAMINE INJ 250MG/25ML VIAL",2601381,CDM,636,RC,,,OUTPATIENT,,,95.25,76.2,,80.96,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.81,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.81,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.81,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85.73,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.34,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.73,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.25,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.96,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.4,85.73,
"RADICAVA (ENDARAVONE) 30MG/100ML PREMIX",2610140,CDM,636,RC,J1301,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",28.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",26.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.11,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.14,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",19.51,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.1,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",19.51,81,
"RECLAST (ZOLEDRONIC AC) INJ 5MG 100ML",2605009,CDM,636,RC,,,OUTPATIENT,,,5870,4696,,4989.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1467.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1467.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1467.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1195.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3062.44,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3062.44,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3062.44,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3062.44,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",5283,90,,,,,0,"percent of total billed charges","90% of total billed charges",2054.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4032.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5283,90,,,,,0,"percent of total billed charges","90% of total billed charges",3404.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1195.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4989.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1195.72,5283,
"REGLAN (METOCLOPRAMIDE HCL) INJ 10MG",2601386,CDM,636,RC,J2765,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.29,125.18,,11.15,11.15,11.15,"1 through 10","fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.24,63,
"REMDESIVIR 100MG VIAL",2610115,CDM,636,RC,,,OUTPATIENT,,,2320,1856,,1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",580,25,,,,,0,"percent of total billed charges","25% of total billed charges",580,25,,,,,0,"percent of total billed charges","25% of total billed charges",580,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1210.37,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1210.37,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1210.37,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1210.37,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",2088,90,,,,,0,"percent of total billed charges","90% of total billed charges",812,35,,,,,0,"percent of total billed charges","35% of total billed charges",1593.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2088,90,,,,,0,"percent of total billed charges","90% of total billed charges",1345.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.58,2088,
"REMICADE (INFLIXIMAB) INJ 100MG",2601412,CDM,636,RC,J1745,HCPCS,OUTPATIENT,,,2565,2052,,2180.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",39.68,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1338.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1338.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1338.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1338.19,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",31.14,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2308.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1762.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.47,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1487.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.75,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2180.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",30.53,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.47,2308.5,
"ROBAXIN (METHOCARBAMOL) INJ 1000MG",2602802,CDM,636,RC,J2800,HCPCS,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.22,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.91,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.91,274.5,
"ROCEPHIN INJ (CEFTRIAXONE NA) 250MG",2600051,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,120.37,,1.58,1.33,2.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,145.78,49.56,197.11,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.56,125.18,,1.99,1.99,1.99,"1 through 10","fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.54,120.37,,2.15,1.34,7.19,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,126,
"ROCEPHIN INJ (CEFTRIAXONE NA) 500MG",2601061,CDM,636,RC,J0696,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,120.37,,1.58,1.33,2.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,145.78,49.56,197.11,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.56,125.18,,1.99,1.99,1.99,"1 through 10","fee schedule","125.18% of GA fee schedule",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.54,120.37,,2.15,1.34,7.19,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.54,243,
"SODIUM NITROPRUSSIDE INJ 50MG",2610169,CDM,636,RC,,,OUTPATIENT,,,23,18.4,,19.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",5.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.05,35,,,,,0,"percent of total billed charges","35% of total billed charges",15.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.7,90,,,,,0,"percent of total billed charges","90% of total billed charges",13.34,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.69,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",19.55,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.69,20.7,
"SOLU-CORTEF (HYDROCORTISONE) INJ 100MG",2601389,CDM,636,RC,J1720,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.25,40.5,
"SOLU-CORTEF (HYDROCORTISONE) INJ 250MG",2601390,CDM,636,RC,J1720,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.21,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.21,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.25,40.5,
"SOLU-MEDROL (METHYLPREDNIS) INJ 1000MG",2601409,CDM,636,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"SOLU-MEDROL (METHYLPREDNIS) INJ 125MG",2601294,CDM,636,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"SOLU-MEDROL (METHYLPREDNISOLONE)INJ 40MG",2602203,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SOTROVIMAB 500MG/8ML VIAL",2610146,CDM,636,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"STADOL (BUTORPHANOL) INJ 1MG",2601178,CDM,636,RC,J0595,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.84,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.84,40.5,
"TALWIN (PENTAZOCINE LACTATE) INJ 30MG",2601185,CDM,636,RC,J3070,HCPCS,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"THORAZINE (CHLORPROMAZINE HCL) INJ 25MG",2602853,CDM,636,RC,J3230,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.15,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.69,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.25,40.5,
"TIGAN (TRIMETHOBENZAMIDE) 200MG/2ML AMP",2601410,CDM,636,RC,J3250,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.78,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.33,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.25,63.78,
"TNKASE IV (TENECTEPLASE) INJ 50MG",2605126,CDM,636,RC,J3101,HCPCS,OUTPATIENT,,,20360,16288,,17306,85,,,,,0,"percent of total billed charges","85% of total billed charges",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",211.15,130,,,,,0,"fee schedule","130% of CMS OPPS rate",4147.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",10622.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",10622.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",10622.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",10622.02,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",165.67,102,,,,,0,"fee schedule","102% of CMS OPPS rate",18324,90,,,,,0,"percent of total billed charges","90% of total billed charges",7126,35,,,,,0,"percent of total billed charges","35% of total billed charges",13987.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",146.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",11808.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",4147.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17306,85,,,,,0,"percent of total billed charges","85% of total billed charges",162.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",146.18,18324,
"TOBRAMYCIN INJ 80MG",2602278,CDM,636,RC,J3260,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.47,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.37,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.37,40.5,
"TORADOL (KETORALAC) INJ 30MG",2602844,CDM,636,RC,J1885,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.88,130,,,,,0,"fee schedule","130% of CMS OPPS rate",0.9,120.37,,1.42,1.13,1.70,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,1.49,0.39,21.58,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.69,102,,,,,0,"fee schedule","102% of CMS OPPS rate",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.94,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,43.81,43.81,43.81,"1 through 10","percent of total billed charges","68.7% of total billed charges",0.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.6,90,,,,,0,"fee schedule","90% of CMS OPPS rate",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.9,120.37,,0.78,0.78,1.12,12,"fee schedule","120.37% of GA fee schedule",0.68,100,,0.54,0.47,1.18,74,"fee schedule","100% of CMS OPPS rate",0.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.68,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.6,58.5,
"TRANEXAMIC ACID 1000MG INJ",2602143,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"VALIUM (DIAZEPAM) INJ 10MG",2602146,CDM,636,RC,J3360,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.29,120.37,,15.07,15.07,15.07,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.7,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.29,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.29,40.5,
"VANCOCIN (VANCOMYCIN) INJ 500MG",2601414,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"VANCOMYCIN 1500MG IV PREMIX 300ML",2610145,CDM,636,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"VANCOMYCIN 1750MG IV PREMIX 350ML",2610181,CDM,636,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"VASOTEC (ENALAPRILAT) INJ 2.5MG",2601421,CDM,636,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"VENOFER (IRON SUCROSE) 200MG/10ML VIAL",2601328,CDM,636,RC,J1756,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.28,120.37,,50.21,50.21,50.21,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,1227.60,392.41,1273.64,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.29,125.18,,50.12,50.12,50.12,"1 through 10","fee schedule","125.18% of GA fee schedule",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.28,13.5,
"VERAPAMIL INJ 2.5MG/ML",2601340,CDM,636,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"VERSED (MIDAZOLAM HCL) INJ 2MG",2601430,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.16,125.18,,0.36,0.36,0.36,"1 through 10","fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.16,40.5,
"VERSED (MIDAZOLAM HCL) INJ 50MG",2601427,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.16,125.18,,0.36,0.36,0.36,"1 through 10","fee schedule","125.18% of GA fee schedule",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.16,27,
"VERSED (MIDAZOLAM HCL) INJ 5MG",2601429,CDM,636,RC,J2250,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.16,125.18,,0.36,0.36,0.36,"1 through 10","fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.16,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.16,40.5,
"VIBRAMYCIN (DOXYCYCLINE) INJ 100MG",2601055,CDM,636,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"VISTARIL (HYDROXYZINE HCL) 50MG IM INJ",2601416,CDM,636,RC,J3410,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.41,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.82,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.82,103.5,
"VITAMIN B-1 (THIAMINE HCL) INJ 100MG",2602845,CDM,636,RC,J3411,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"ZINACEF INJ 750MG",2601024,CDM,636,RC,J0697,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.37,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.27,40.5,
"ZITHROMAX INJ 500MG",2602338,CDM,636,RC,J0456,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"ZOFRAN (ONDANSETRON HCL) INJ 4MG",2601408,CDM,636,RC,J2405,HCPCS,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.11,120.37,,0.38,0.33,0.42,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,28.37,11.89,28.59,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.11,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.11,120.37,,0.40,0.40,0.40,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.11,63,
"ZOVIRAX (ACYCLOVIR) INJ 500MG",2601050,CDM,636,RC,J0133,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.06,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.06,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.06,126,
"ZYPREXA (OLANZAPINE) INJ 10MG/ML",2605064,CDM,636,RC,,,OUTPATIENT,,,120,96,,102,85,,,,,0,"percent of total billed charges","85% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",30,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",42,35,,,,,0,"percent of total billed charges","35% of total billed charges",82.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",108,90,,,,,0,"percent of total billed charges","90% of total billed charges",69.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",24.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",102,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",24.44,108,
"ZYVOX (LINEZOLID) IVPB  600MG/300ML",2601419,CDM,636,RC,J2020,HCPCS,OUTPATIENT,,,840,672,,714,85,,,,,0,"percent of total billed charges","85% of total billed charges",210,25,,,,,0,"percent of total billed charges","25% of total billed charges",210,25,,,,,0,"percent of total billed charges","25% of total billed charges",210,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",438.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",438.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",438.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",438.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",577.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",487.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.59,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",714,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.59,756,
"BICILLIN-LA (PEN G BENZ) INJ 1.2MU",2601011,CDM,636,RC,J0561,HCPCS,OUTPATIENT,,,405,324,,344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.86,130,,,,,0,"fee schedule","130% of CMS OPPS rate",32.28,120.37,,23.63,23.63,23.63,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27.35,102,,,,,0,"fee schedule","102% of CMS OPPS rate",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.57,125.18,,30.01,30.01,30.01,"1 through 10","fee schedule","125.18% of GA fee schedule",278.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.13,90,,,,,0,"fee schedule","90% of CMS OPPS rate",234.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",32.28,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.82,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.13,364.5,
"AMPHADASE (HYALURONIDASE) 150 UNITS/ML",2610192,CDM,636,RC,J3470,HCPCS,OUTPATIENT,,,80.5,64.4,,68.43,85,,,,,0,"percent of total billed charges","85% of total billed charges",20.13,25,,,,,0,"percent of total billed charges","25% of total billed charges",20.13,25,,,,,0,"percent of total billed charges","25% of total billed charges",20.13,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.45,90,,,,,0,"percent of total billed charges","90% of total billed charges",28.18,35,,,,,0,"percent of total billed charges","35% of total billed charges",55.3,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72.45,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.69,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68.43,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.4,72.45,
"DIPRIVAN (PROPOFOL 1%) VIAL 50ML",2601158,CDM,636,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"EXPAREL (BUPIVACAINE LIPOSOME) 1.3% VIAL",2610151,CDM,636,RC,J0666,HCPCS,OUTPATIENT,,,1280,1024,,1088,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.31,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.31,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.31,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.7,130,,,,,0,"fee schedule","130% of CMS OPPS rate",260.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",667.79,52.17,,648.18,2.36,2046.00,"1 through 10","percent of total billed charges","52.17% of total billed charges",667.79,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",667.79,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",667.79,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1152,90,,,,,0,"percent of total billed charges","90% of total billed charges",448,35,,,,,0,"percent of total billed charges","35% of total billed charges",879.36,68.7,,1.14,1.14,1.14,"1 through 10","percent of total billed charges","68.7% of total billed charges",1.31,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.18,90,,,,,0,"fee schedule","90% of CMS OPPS rate",742.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",260.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1.31,100,,2.78,1.12,111.41,64,"fee schedule","100% of CMS OPPS rate",1.31,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1088,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.31,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.18,1152,
"INDIGO CARMINE 0.8% SOLUTION",2600008,CDM,636,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"INFLUENZA VIRUS VACCINE : ADULT (>36MOS)",2600076,CDM,636,RC,90658,HCPCS,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.36,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.75,67.5,
"MARCAINE (BUPIVACAINE) SPINAL AMP 2ML",2602209,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MARCAINE 0.25% (BUPIVACAINE) VIAL 30ML",2601355,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MARCAINE 0.5% (BUPIVACAINE) VIAL 30ML",2603019,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MURI-LUBE (LIGHT MINERAL OIL) 10ML VIAL",2610150,CDM,636,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"NAROPIN (ROPIVACAINE) 0.5% VIAL 30ML",2610128,CDM,636,RC,J2795,HCPCS,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"PNEUMOCOCCAL VACCINE INJ 0.5ML",2605096,CDM,636,RC,90732,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",160.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",167.08,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",160.66,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,297,
"POLOCAINE (MEPIVACAINE) 2% VIAL 50ML",2610129,CDM,636,RC,J0670,HCPCS,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",4.44,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.27,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.27,36,
"RABIES IMMUNE GLOB 150UNIT/ML 2ML VIAL",2601041,CDM,636,RC,90375,HCPCS,OUTPATIENT,,,985,788,,837.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",364.48,130,,,,,0,"fee schedule","130% of CMS OPPS rate",337.48,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",513.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",513.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",513.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",513.88,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",285.97,102,,,,,0,"fee schedule","102% of CMS OPPS rate",886.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",350.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",676.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",252.33,90,,,,,0,"fee schedule","90% of CMS OPPS rate",571.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",337.48,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",837.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",252.33,886.5,
"TETANUS DIPHTHERIA INJ 0.5ML",2601048,CDM,636,RC,90714,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,25.15,25.15,25.15,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"XYLOCAINE 0.5% MPF (LIDOCAINE) VIAL 50ML",2602292,CDM,636,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"XYLOCAINE 1% (LIDOCAINE HCL) AMP 10ML",2605086,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"XYLOCAINE 1% (LIDOCAINE HCL) INJ 5ML",2601348,CDM,636,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"XYLOCAINE 1% (LIDOCAINE) MPF VIAL 30ML",2603016,CDM,636,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"XYLOCAINE 2% (LIDOCAINE HCL) VIAL 5ML",2601349,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"XYLOCAINE 2% (LIDOCAINE) UROJET 5ML",2600015,CDM,636,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"XYLOCAINE 2% (LIDOCAINE) VIAL 10ML",2603018,CDM,636,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"XYLOCAINE 2% W/EPI (LIDO/EPI) VIAL 20ML",2603017,CDM,636,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"PENICILLIN G POT INJ 5MU",2602283,CDM,636,RC,,,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,274.5,
"BACITRACIN INJ : 50,000 UNITS",2601314,CDM,636,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BOTOX 100 UNIT VIAL",2620008,CDM,636,RC,J0585,HCPCS,OUTPATIENT,,,2705,2164,,2299.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",1411.23,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1411.23,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1411.23,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1411.23,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",6.59,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2434.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.1,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",1858.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.82,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1568.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.79,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2299.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.82,2434.5,
"EPOGEN/PROCRIT (EPOETIN) INJ 10,000UNITS",2601280,CDM,636,RC,Q4081,HCPCS,OUTPATIENT,,,1210,968,,1028.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",302.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",302.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",302.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",631.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",631.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",631.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",631.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1089,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.81,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",831.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1089,90,,,,,0,"percent of total billed charges","90% of total billed charges",701.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1028.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.78,1089,
"EPOGEN/PROCRIT (EPOETIN) INJ 20,000UNITS",2602236,CDM,636,RC,,,OUTPATIENT,,,2130,1704,,1810.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",532.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",532.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",532.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",433.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1111.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1111.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1111.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",1111.24,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",1917,90,,,,,0,"percent of total billed charges","90% of total billed charges",745.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1463.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1917,90,,,,,0,"percent of total billed charges","90% of total billed charges",1235.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",433.88,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1810.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",433.88,1917,
"HEPARIN FLUSH -LOC 500 UNITS/ 5ML",2601311,CDM,636,RC,J1642,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.03,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.02,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.02,40.5,
"HEPARIN SODIUM INJ 5000 UNITS",2601319,CDM,636,RC,J1644,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.24,120.37,,1.17,1.17,1.17,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.25,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.24,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.24,40.5,
"HUMALOG 75/25 (INSULIN MIX) 1 DOSE",2600016,CDM,636,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"HUMULIN 70/30 KWIKPEN",2605045,CDM,636,RC,J1817,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"PITOCIN (OXYTOCIN) INJ 10 UNITS",2601373,CDM,636,RC,J2590,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"RABIES IMMUNE GLOB 150UNIT/ML 10ML VIAL",2601040,CDM,636,RC,90375,HCPCS,OUTPATIENT,,,4545,3636,,3863.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",364.48,130,,,,,0,"fee schedule","130% of CMS OPPS rate",337.48,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",2371.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2371.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2371.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2371.17,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",285.97,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4090.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",350.97,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",3122.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",252.33,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2636.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",337.48,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3863.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",280.37,100,,,,,0,"fee schedule","100% of CMS OPPS rate",252.33,4090.5,
"RETAVASE (RETEPLASE) 20 UNITS KIT",2605047,CDM,636,RC,J2993,HCPCS,OUTPATIENT,,,14720,11776,,12512,85,,,,,0,"percent of total billed charges","85% of total billed charges",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3610.28,130,,,,,0,"fee schedule","130% of CMS OPPS rate",2998.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",7679.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7679.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7679.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",7679.57,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2832.68,102,,,,,0,"fee schedule","102% of CMS OPPS rate",13248,90,,,,,0,"percent of total billed charges","90% of total billed charges",5152,35,,,,,0,"percent of total billed charges","35% of total billed charges",10112.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2499.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",8537.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",2998.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12512,85,,,,,0,"percent of total billed charges","85% of total billed charges",2777.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2499.42,13248,
"VASOPRESSIN INJ 20UNITS",2605158,CDM,636,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CROFAB (ANTIVENIN CROTALIDAE) INJ",2605136,CDM,636,RC,,,OUTPATIENT,,,6980,5584,,5933,85,,,,,0,"percent of total billed charges","85% of total billed charges",1745,25,,,,,0,"percent of total billed charges","25% of total billed charges",1745,25,,,,,0,"percent of total billed charges","25% of total billed charges",1745,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1421.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3641.54,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3641.54,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3641.54,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3641.54,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",6282,90,,,,,0,"percent of total billed charges","90% of total billed charges",2443,35,,,,,0,"percent of total billed charges","35% of total billed charges",4795.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6282,90,,,,,0,"percent of total billed charges","90% of total billed charges",4048.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1421.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5933,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1421.83,6282,
APLIGRAF,1570050,CDM,636,RC,Q4101,HCPCS,OUTPATIENT,,,6145,4916,,5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",3205.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3205.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3205.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",3205.91,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2150.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4221.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5530.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3564.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",1251.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5223.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1251.74,5530.5,
"BB RHO(D) INJECTION",3000276,CDM,636,RC,J2790,HCPCS,OUTPATIENT,,,530,424,,450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",132.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",100.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.35,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",364.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",477,90,,,,,0,"percent of total billed charges","90% of total billed charges",307.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",100.34,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",450.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.01,477,
"CT ISOVUE 300 mgI/ml 10x100ml VIALS",4209967,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"CT ISOVUE 300 mgI/ml 10x30ml VIALS",4209965,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT ISOVUE 300 mgI/ml 10x50ml VIALS",4209966,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT ISOVUE 370 mgI/ml 10x100ml VIALS",4209968,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"CT ISOVUE 370 mgI/ml 10x75ml VIALS",4209969,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT OMNIPAQUE PER ML LOW OSMOLAR",4200014,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CT ULTRAVIST 240 mgI/ml 10x50ml VIALS",4200018,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT ULTRAVIST 300 mgI/ml 10x100ml VIALS",4200015,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT ULTRAVIST 300 mgI/ml 10x50ml VIALS",4200019,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT ULTRAVIST 300 mgl/ml 10x200ml VIALS",4200016,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CT ULTRAVIST 370mgl/ml 10x100ml VIALS",4200017,CDM,636,RC,Q9967,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,608.81,315.80,773.35,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,1950.01,1950.01,1950.01,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"EPOGEN 1000 UNITS (</= 10000 UNITS)",2600020,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.39,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.58,102,,,,,0,"fee schedule","102% of CMS OPPS rate",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.81,90,,,,,0,"fee schedule","90% of CMS OPPS rate",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.81,103.5,
"EPOGEN 1000 UNITS (> 10000 UNITS)",2600021,CDM,636,RC,J0885,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.39,130,,,,,0,"fee schedule","130% of CMS OPPS rate",7.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6.58,102,,,,,0,"fee schedule","102% of CMS OPPS rate",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.81,90,,,,,0,"fee schedule","90% of CMS OPPS rate",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.78,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",5.81,202.5,
"FLUVIRIN INFLU  VACCINE : ADULT (>4YRS)",2600155,CDM,636,RC,Q2039,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",87.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",71.3,315,
"GENTAMICIN FOR IRRIGATION 100 MG",2602232,CDM,636,RC,J1580,HCPCS,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.09,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.97,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.97,166.5,
"GRAFTJACKET MATRIX",1570055,CDM,636,RC,Q4107,HCPCS,OUTPATIENT,,,5280,4224,,4488,85,,,,,0,"percent of total billed charges","85% of total billed charges",1320,25,,,,,0,"percent of total billed charges","25% of total billed charges",1320,25,,,,,0,"percent of total billed charges","25% of total billed charges",1320,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1075.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2754.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2754.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2754.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",2754.63,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",4752,90,,,,,0,"percent of total billed charges","90% of total billed charges",1848,35,,,,,0,"percent of total billed charges","35% of total billed charges",3627.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4752,90,,,,,0,"percent of total billed charges","90% of total billed charges",3062.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1075.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4488,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1075.54,4752,
"INFLUENZA PED. VACCINE : 6-35 MONTHS",2605002,CDM,636,RC,90658,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",27.36,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.31,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.31,103.5,
"LABOR/DELIVERY KIT",2600158,CDM,636,RC,J2590,HCPCS,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"MEFOXIN INJ (CEFOXITIN) 1GM",2662523,CDM,636,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MIOCHOL-E (A-CHOLINE) INTRAOCULAR 1KIT",2660019,CDM,636,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"MRI MAGNEVIST VIAL 15ML",4476403,CDM,636,RC,A9579,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,61.09,61.09,61.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MRI MAGNEVIST VIAL 20ML",4476404,CDM,636,RC,A9579,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,61.09,61.09,61.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MRI MULTIHANCE VIAL 15ML",4476405,CDM,636,RC,A9579,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,61.09,61.09,61.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MRI MULTIHANCE VIAL 20ML",4476406,CDM,636,RC,A9579,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,61.09,61.09,61.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MRI PROHANCE VIAL 15ML",4476407,CDM,636,RC,A9579,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,61.09,61.09,61.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MRI PROHANCE VIAL 20ML",4476408,CDM,636,RC,A9579,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,61.09,61.09,61.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NM KINEVAC INJ 5 MCG",4500037,CDM,636,RC,J2805,HCPCS,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,346.5,
"NM TC99M MDP",4500040,CDM,636,RC,A9503,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",73.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",60.09,265.5,
"NOVOLIN N (INSULIN HUMAN-N) INJ : 1DOSE",2660017,CDM,636,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"OMNIPAQUE  200-249 MH/ML",4000038,CDM,636,RC,Q9966,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OPTIRAY 200-249 MH/ML",4000033,CDM,636,RC,Q9966,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RABIES VACCINE INJECTION : 1ML",2601046,CDM,636,RC,90675,HCPCS,OUTPATIENT,,,540,432,,459,85,,,,,0,"percent of total billed charges","85% of total billed charges",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",426.11,130,,,,,0,"fee schedule","130% of CMS OPPS rate",394.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",0.01,,,,,,0,other,"not separately reimbursable",334.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",486,90,,,,,0,"percent of total billed charges","90% of total billed charges",410.32,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",370.98,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",295,90,,,,,0,"fee schedule","90% of CMS OPPS rate",313.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",394.55,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",459,85,,,,,0,"percent of total billed charges","85% of total billed charges",327.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.01,486,
"SOLU-MEDROL (METHYLPREDNIS) INJ 500MG",2601406,CDM,636,RC,,,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",37.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",30.56,135,
"STROKE KIT",2600166,CDM,636,RC,J2590,HCPCS,OUTPATIENT,,,21915,17532,,18627.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",5478.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5478.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",5478.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4464.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11433.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",11433.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",11433.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",11433.27,52.17,,,,,0,"percent of total billed charges","52.17% of total billed charges",,,,,,,0,other,"not separately reimbursable",19723.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",7670.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",15055.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",19723.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12710.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",4464.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18627.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4464.09,19723.5,
"VISULIZATION ADJUNCT",2601008,CDM,636,RC,Q9968,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11.57,130,,,,,0,"fee schedule","130% of CMS OPPS rate",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.01,90,,,,,0,"fee schedule","90% of CMS OPPS rate",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.9,100,,50.76,35.54,65.98,"1 through 10","fee schedule","100% of CMS OPPS rate",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.9,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.01,81,
"XR OPTIRAY (ULTRAVIST 240 mgI) HYSTERIO",4000035,CDM,636,RC,Q9966,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XYLO PUDENDAL SYRINGE INJ 30ML",2601435,CDM,636,RC,,,OUTPATIENT,,,110,88,,93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",27.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",38.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",75.57,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",99,90,,,,,0,"percent of total billed charges","90% of total billed charges",63.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",22.41,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",93.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.41,99,
"XYLOCAINE 1% (LIDOCAINE) VIAL: 20ML",2603005,CDM,636,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"A&D (VITAMIN A&D) OINTMENT : 5GM",2600402,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AQUAPHOR 1.75OZ OINTMENT TUBE",2600111,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ASPERCREME (TROLAMINE SALICYLATE) 85GM",2612001,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"AVC (SULFANILAMIDE) VAG CREAM",2600266,CDM,637,RC,,,OUTPATIENT,,,290,232,,246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",72.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",163.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",101.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",199.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",261,90,,,,,0,"percent of total billed charges","90% of total billed charges",168.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",59.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",246.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",59.07,261,
"BACITRACIN EYE OINTMENT 3.5GM",2605000,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"BACITRACIN OINTMENT PACKETS",2605057,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BACTROBAN (MUPIROCIN) 2% OINT",2600064,CDM,637,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"CALAMINE (ZINC OXIDE) LOTION",2600406,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CALMOSEPTINE (ZINC OXIDE/MENTHOL) OINT",2605055,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"DESITIN DIAPER OINTMENT 1 OZ",2650015,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DIPHENHYDRAMINE 2% CREAM 28GM",2600103,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DIPROSONE (BETAMETHASONE) 0.05% CRM",2605065,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"EMLA (PRILOCAINE/LIDOCAINE)CRM : 5GM",2605183,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"ERYTHROMYCIN OPHT OINT 1GM",2600329,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ERYTHROMYCIN OPHTHALMIC OINT 3.5GM",2600338,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EUCERIN MOISTURIZING CREAM 57GM",2600009,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GENTAMICIN 0.1% CRM 15GM",2600422,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GENTAMICIN 0.1% OINT 15GM",2605117,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"HYDROCORTISONE 1% CREAM",2600425,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"HYDROCORTISONE 1% LOTION 118ML",2600430,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"KENALOG ORIBASE (TRIAMCIN) 0.1% PASTE",2600431,CDM,637,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"LAC-HYDRIN (AMLACTIN) 12% LOTION",2605032,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LACRILUBE (ARTIFICIAL TEARS) OPHTH OINT",2600042,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LAMISIL (TERBINAFINE HCL) 1% CRM",2600436,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LANOLIN (LANOLIN BREAST OINT) 30GM",2600084,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
LOTRISONE(CLOTRIMAZOLE/BETAMETHASONE)CRM,2600448,CDM,637,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"MICONAZOLE (MICRO-GUARD) POWDER 85GM",2600115,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MONISTAT-7 (MICONAZOLE NIT) VAG CRM",2600260,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"MYCELEX (CLOTRIMAZOLE) 1% CREAM 15GM",2600079,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MYCOLOG (NYSTATIN/TRIAMCINO) CRM 15GM",2600441,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MYCOLOG (NYSTATIN/TRIAMCINO) OINT 15GM",2600442,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NEOSPORIN (NEOMYCIN/BACI/POLY B) OINT",2600324,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NIZORAL (KETOCONAZOLE) 2% CRM",2602205,CDM,637,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"NUPERCAINAL (DIBUCAINE) 1% : 30GM",2610007,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NUPERCAINAL (DIBUCAINE) 1% 28 GM OINT",2600092,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NYSTATIN POWDER 15GM TOPICAL",2602276,CDM,637,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"PREMARIN (ESTROGEN CONJ) VAG CRM 0.625MG",2605149,CDM,637,RC,,,OUTPATIENT,,,610,488,,518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",152.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",152.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",152.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",124.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",344.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",213.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",419.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",549,90,,,,,0,"percent of total billed charges","90% of total billed charges",353.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",124.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",518.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",124.26,549,
"PROCTOSOL-HC (HYDROCORT) 2.5% CRM 30GM",2600252,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SILVADENE (SILVER SULFAD.)1% CRM 50GM",2600453,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"SILVER SULFADIAZINE 1% CREAM 400GM",2600094,CDM,637,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"TERAZOL-3 (TERCONAZOLE) VAG CRM",2600259,CDM,637,RC,,,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"TOBRADEX (TOBRAMYCIN/DEX) OPHT OINT",2603080,CDM,637,RC,,,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"TOBREX (TOBRAMYCIN) OPHT OINT",2603090,CDM,637,RC,,,OUTPATIENT,,,325,260,,276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",81.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",183.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",113.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",223.28,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",292.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",188.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",66.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",276.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",66.2,292.5,
"TRIAMCINOLONE 0.1% CRM",2600429,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TRIAMCINOLONE 0.1% LOTION 60ML",2600010,CDM,637,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"VALISONE (BETAMETHASONE VAL) 0.1% CRM",2600027,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"BSS IRR (BAL SALT SOLUTION):500ML",2601288,CDM,637,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"AGGRENOX  CAP 25MG/200MG",2605147,CDM,637,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"CHROMAGEN (IRON/B12/FA/IF) CAP",2605110,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"FIORICET #3 (ACET/CAF/BUTAL/COD) CAP",2605121,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FIORINAL #3 (ASA/CAF/BUTAL/COD) CAP",2605119,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LIBRAX (CLIDINIUM/CHLORDIAZEPOXIDE) CAP",2602690,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LOVAZA(OMEGA-3 ETHYL) CAP",2600151,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MEPERGAN FORTIS (MEPERIDINE/PROMETH) CAP",2602004,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"MIDRIN (ISOMETH/DICHLOR/APAP) CAP",2600029,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PANCREASE (PANCRELIPASE) CAP",2602757,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NON-FORM $10 TAB",2600100,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NON-FORM $5 TAB",2600105,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SPIRIVA HANDIHALER 18MCG (5 COUNT)",2600120,CDM,637,RC,,,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"HUMALOG 75/25 10 ML",2660018,CDM,637,RC,J1815,HCPCS,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,58.5,
"NOVOLIN R (INSULIN HUMAN-R) INJ : 1DOSE",2660016,CDM,637,RC,J1815,HCPCS,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,9,
"AURALGAN (BENZOCAINE/ANTIPYRINE) OTIC",2600101,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"BETOPTIC (BETAXOLOL) 0.5% OPHTH SOL",2600302,CDM,637,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"BLEPHAMIDE (SULFACET/PRED) OPHTH DROP",2600343,CDM,637,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"BSS (BALANCED SALT SOLUTION) DROPS:15ML",2601289,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"CIPRODEX OTIC SUSPENSION",2600518,CDM,637,RC,,,OUTPATIENT,,,450,360,,382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",112.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",254.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",157.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",309.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",405,90,,,,,0,"percent of total billed charges","90% of total billed charges",261,58,,,,,0,"percent of total billed charges","58% of total billed charges",91.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",382.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",91.67,405,
"DEBROX EAR DROPS 15ML",2600102,CDM,637,RC,,,OUTPATIENT,,,115,92,,97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",28.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",64.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",79.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",103.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",23.43,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",97.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",23.43,103.5,
"GARAMYCIN (GENTAMICIN SULF)0.3% OPH DROP",2600340,CDM,637,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"LEVSIN (HYOSCYAMINE) 0.125MG/1ML DROPS",2600840,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MYLICON (SIMETHICONE) DROPS",2602728,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NEOSPORIN (NEO/GRAM/POLY-B) EYE DROP",2600325,CDM,637,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"NON-FORMULARY OPHTH DROP",2600099,CDM,637,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"PILOCAR 1% (PILOCARPINE) OPHT DROP",2600316,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PILOCAR 2% (PILOCARPINE) OPHT DROP",2600317,CDM,637,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"PILOCAR 3% (PILOCARPINE) OPHT DROP",2600318,CDM,637,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"PILOCAR 4% (PILOCARPINE) OPHT DROP",2600319,CDM,637,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"PRED FORTE (PREDNISOLONE) 1% OPHT DROP",2600311,CDM,637,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"SULAMYD 10% (SULFACETAMIDE SOD)OPHT DROP",2600330,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"TEARS NATURALE (ARTIFICIAL TEARS) OPHTH",2600301,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"TIMOPTIC XE (TIMOLOL GFS) 0.5% OPHT DROP",2600332,CDM,637,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"TOBRAMYCIN 0.3% OPHTHALMIC DROPS",2600041,CDM,637,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"TYMPAGESIC (BENZ/PHEN/ANTIPYR) OTIC",2600106,CDM,637,RC,,,OUTPATIENT,,,75,60,,63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",18.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",42.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",51.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",15.28,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",63.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",15.28,67.5,
"VIGAMOX EYE DROPS (MOXIFLOXACIN) 3 ML",2605001,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"XALATAN (LATANOPROST) 0.005% EYE DROPS",2610004,CDM,637,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"ZOTO-HC OTIC DROPS",2605044,CDM,637,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"FUL-GLO 1MG OPHTHALMIC STRIPS 100'S",2600013,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NYSTATIN CRM",2600443,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"IV PCA PUMP SET MED",2610519,CDM,637,RC,,,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",45,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,,,,0,"percent of total billed charges","35% of total billed charges",123.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",36.67,162,
"FLEET M.O (MINERAL OIL) ENEMA",2600258,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ACTIDOSE (CHARCOAL AQUEOUS) 50GM/240ML",2603000,CDM,637,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"CARAFATE (SUCRALFATE) LIQ 1GM/10ML",2602547,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CARAFATE (SUCRALFATE) TAB 1GM",2602551,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COLESTIPOL(COLESTID) 1GM",2600147,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FISH OIL (OMEGA-3) 1000MG CAP",2600188,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KAYEXALATE (SPS) LIQ 15GM",2605014,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MIRALAX PAK (PEG 3350 U.D.) PWD 17GM",2605176,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"QUESTRAN (CHOLESTYRAMINE) POWDER 4GM",2602791,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZITHROMAX (AZITHROMYCIN) 1GM PACKET",2600024,CDM,637,RC,Q0144,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"ZOVIRAX OINT 5% 5GM",2600468,CDM,637,RC,,,OUTPATIENT,,,280,224,,238,85,,,,,0,"percent of total billed charges","85% of total billed charges",70,25,,,,,0,"percent of total billed charges","25% of total billed charges",70,25,,,,,0,"percent of total billed charges","25% of total billed charges",70,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",158.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",98,35,,,,,0,"percent of total billed charges","35% of total billed charges",192.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",252,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",57.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",238,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",57.04,252,
"PULMICORT FLEXHALER 180MCG MDI",2600119,CDM,637,RC,,,OUTPATIENT,,,525,420,,446.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",131.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",106.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",296.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",296.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",296.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",296.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",183.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",360.68,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",472.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",304.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",106.94,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",446.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",106.94,472.5,
"VITAMIN D3 TAB 5,000 IU",2610139,CDM,637,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"FLEET PREP KIT#3",2660002,CDM,637,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"CEPACOL (BENZOCAINE) LOZENGE",2600072,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CEPASTAT (PHENOL) LOZENGE : BOX",2602553,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CALCITRIOL 0.25MCG CAP",2625161,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CYTOTEC (MISOPROSTOL) TAB 100MCG",2605130,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CYTOTEC VAG (MISOPROSTOL) VAG : 25MCG",2605124,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"DURAGESIC (FENTANYL) PATCH 12MCG",2602266,CDM,637,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DURAGESIC (FENTANYL) PATCH 25MCG",2602267,CDM,637,RC,,,OUTPATIENT,,,125,100,,106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",31.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",70.63,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",43.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",85.88,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",112.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",72.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",25.46,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",106.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",25.46,112.5,
"DURAGESIC (FENTANYL) PATCH 50MCG",2602611,CDM,637,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"NF-SYNTHROID (LEVOTHYROXINE) TAB 25MCG",2602828,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SYNTHROID (LEVOTHYROXINE) INJECT 200MCG",2602831,CDM,637,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"SYNTHROID (LEVOTHYROXINE) TAB 100MCG",2602830,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SYNTHROID (LEVOTHYROXINE) TAB 112MCG",2602829,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SYNTHROID (LEVOTHYROXINE) TAB 125MCG",2605067,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SYNTHROID (LEVOTHYROXINE) TAB 150MCG",2603068,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SYNTHROID (LEVOTHYROXINE) TAB 50MCG",2602827,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SYNTHROID (LEVOTHYROXINE) TAB 75MCG",2603056,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SYNTHROID (LEVOTHYROXINE) TAB 88MCG",2660001,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KCL 10% (POTASSIUM CL) UD LIQ 20MEQ",2600839,CDM,637,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"NF-POTASSIUM CHLORIDE TAB 8MEQ",2602818,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"POTASSIUM CHLORIDE (K-DUR) TAB 10MEQ",2610113,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"POTASSIUM CHLORIDE (K-DUR) TAB 20MEQ",2600058,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ABILIFY (ARIPIPRAZOLE) TAB 10MG",262512,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ABILIFY (ARIPIPRAZOLE) TAB 5MG",2610120,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ACCOLATE (ZAFIRLUKAST) TAB : 20MG",2602240,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ACCUPRIL (QUINAPRIL) TAB 20MG",2605093,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ACCUPRIL (QUINAPRIL) TAB 5MG",2605069,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ACTOS (PIOGLITAZONE) TAB : 30MG",2605109,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"ADALAT CC (NIFEDIPINE ER) TAB 30MG",2602787,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ADALAT CC (NIFEDIPINE ER) TAB 60MG",2602788,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ADVIL (IBUPROFEN) TAB : 200MG",2602511,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ALBENDAZOLE TAB 200MG",2610179,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ALDACTONE (SPIRONOLACTONE) TAB 25MG",2602502,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ALDOMET (METHYLDOPA) TAB 250MG",2605088,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ALLEGRA (FEXOFENADINE) TAB 180MG",2605071,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ALTACE (RAMIPRIL) CAP 2.5MG",2605152,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AMARYL (GLIMEPIRIDE) TAB 2MG",2603043,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AMBIEN (ZOLPIDEM TARTRATE) TAB 10MG",2602103,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"AMOXICILLIN CAP 500MG",2602301,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AMOXICILLIN DROPS 50MG/ML 15ML",2600700,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"AMOXICILLIN SUSP 125MG/5ML 150ML",2600018,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"AMOXICILLIN SUSP 250MG/5ML 100ML",2600702,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"AMOXICILLIN UD SUSP 250MG/5ML",2600019,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AMOXICLLIN CAP 250MG",2602300,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ANTIVERT (MECLIZINE) TAB : 25MG",2602509,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ANUSOL HC (HYDROCORTISONE) SUPP 25MG",2600200,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"APRESOLINE (HYDRALAZINE HCL) TAB : 50MG",2602514,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"APRESOLINE (HYDRALAZINE HCL) TAB 25MG",2602513,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"APRESOLINE(HYDRALAZINE) 10MG",2600145,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ARICEPT (DONEPEZIL) TAB 10MG",2600163,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"ARICEPT (DONEPEZIL) TAB 5MG",2603088,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"ASACOL (MESALAMINE) TAB 400MG",2605043,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ASPIRIN 300MG SUPPOSITORY",2602524,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ASPIRIN CHEWABLE TAB 81MG",2602520,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ASPIRIN EC TAB 325MG",2602521,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ASPIRIN EC TAB 81MG",2602522,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ASPIRIN TAB 325MG",2602518,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ATARAX (HYDROXYZINE) LIQ 10MG/5ML",2600898,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ATIVAN (LORAZEPAM) TAB 0.5MG",2600081,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ATIVAN (LORAZEPAM) TAB 1MG",2602101,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AUGMENTIN (AMOXICILLIN/CLAV) TAB 500MG",2602305,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"AUGMENTIN (AMOXICILLIN/CLAV) TAB 875MG",2602309,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"AUGMENTIN SUSP 600MG/5ML 75ML",2600708,CDM,637,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"AVANDIA (ROSIGLITAZONE) TAB : 2MG",2605050,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AVANDIA (ROSIGLITAZONE) TAB 4MG",2605041,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AVAPRO (IRBESARTAN) TAB 150MG",2605040,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"AVELOX (MOXIFLOXACIN) TAB : 400MG",2605132,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"AVODART (DUTASTERIDE) CAP 0.5MG",2601433,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"AZITHROMYCIN SUSP 200MG/5ML 30ML",2602258,CDM,637,RC,Q0144,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"AZULFADINE (SULFASALAZINE E.C. TAB 500MG",2605042,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BACLOFEN TAB 10MG",2602315,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BENADRYL (DIPHENHYDRAMINE) CAP 25MG",2601269,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
BENADRYL(DIPHENHYDRAMINE)LIQ:12.5MG/5ML,2600805,CDM,637,RC,Q0163,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BENICAR (OLMESARTAN) TAB 20MG",2611009,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"BENTYL (DICYCLOMINE HCL) CAP 10MG",2600806,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BENTYL (DICYCLOMINE HCL) LIQ 10MG/5ML",2602533,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"BENTYL (DICYCLOMINE HCL) TAB 20MG",2601270,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"BETAPACE (SOTALOL) TAB 80MG",2605103,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"BIAXIN (CLARITHROMYCIN) TAB 250MG",2602312,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"BIAXIN (CLARITHROMYCIN) TAB 500MG",2602313,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"BIAXIN (CLARITHROMYCIN)125MG/5ML SP:50ML",2602321,CDM,637,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"BIAXIN (CLARITHROMYCIN)250MG/5ML SP:50ML",2603067,CDM,637,RC,,,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"BRETHINE (TERBUTALINE SULF) TAB 2.5MG",2601273,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BRILINTA (TICAGRELOR) TAB 90MG",2610164,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BUMEX (BUMETANIDE) TAB 0.5MG",2602539,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BUMEX (BUMETANIDE) TAB 1MG",2603063,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BUSPAR  (BUSPIRONE) TAB 10MG",2602543,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BUSPAR DIVIDOSE (BUSPIRONE) TAB 15MG",2602544,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"BUTISOL (BUTABARBITAL) TAB 30MG",2605164,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BYSTOLIC (NEBIVOLOL) TAB 10MG",2602241,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CALAN (VERAPAMIL HCL) TAB 80MG",2602673,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CALAN (VERAPAMIL) TAB 120MG",2602674,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CALAN SR (VERAPAMIL SR) CAP 180MG",2602672,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CALAN SR (VERAPAMIL SR) TAB 240MG",2602679,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CANDESARTAN (ATACAND) 16MG TABLET",2600109,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CAPOTEN (CAPTOPRIL) TAB 25MG",2602546,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CARDIZEM (DILTIAZEM CD) CAP 120MG",2602222,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CARDIZEM (DILTIAZEM CD) CAP 180MG",2602237,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CARDIZEM (DILTIAZEM CD) CAP 240MG",2602238,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CARDIZEM (DILTIAZEM CD) CAP 300MG",2603044,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CARDIZEM (DILTIAZEM) TAB 30MG",2600025,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CARDURA (DOXAZOSIN) TAB 1MG",2602550,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CARDURA (DOXAZOSIN) TAB 4MG",2602554,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATAPRES (CLONIDINE HCL) TAB 0.1MG",2602549,CDM,637,RC,J0735,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CEFTIN (CEFUROXIME 50ML) SUSP 125MG/5ML",2605022,CDM,637,RC,,,OUTPATIENT,,,435,348,,369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",108.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",245.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",152.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",298.85,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",391.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",252.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",88.61,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",369.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",88.61,391.5,
"CEFTIN (CEFUROXIME 50ML) SUSP 250MG/5ML",2602337,CDM,637,RC,,,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",82.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",67.22,297,
"CEFTIN (CEFUROXIME AXETIL) TAB 250MG",2602310,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CEFZIL (CEFPROZIL) 125MG/5ML SUSP 50ML",2602323,CDM,637,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"CEFZIL (CEFPROZIL) 250MG/5ML SUSP 50ML",2602324,CDM,637,RC,,,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"CEFZIL (CEFPROZIL) TAB 250MG",2602306,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CELEBREX (CELECOXIB) CAP 100MG",2605007,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CELEBREX (CELECOXIB) CAP 200MG",2605184,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CELEXA (CITALOPRAM HBR) TAB 20MG",2605070,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CHLORAL HYDRATE LIQ : 500MG/5ML",2602104,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CIPRO (CIPROFLOXACIN) TAB 250MG",2602334,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CIPRO (CIPROFLOXACIN) TAB 500MG",2602336,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"CLARITIN (LORATADINE) TAB 10MG",2602557,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CLEOCIN (CLINDAMYCIN HCL) CAP 150MG",2602269,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CLINORIL (SULINDAC) TAB : 150MG",2602214,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CLINORIL (SULINDAC) TAB : 200MG",2603086,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"COGENTIN (BENZTROPINE MESYLATE) TAB 1MG",2602565,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COLACE (DOCUSATE NA) CAP 100MG",2602567,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COLACE (DOCUSATE) SYRUP 50MG/5ML",2603076,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COLCHICINE (COLCRYS) TAB 0.6MG",2602569,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"COMPAZINE (PROCHLORPERAZINE ) TAB 5MG",2602573,CDM,637,RC,Q0164,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"COMPAZINE (PROCHLORPERAZINE) SUPP 25MG",2601282,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CORDARONE (AMIODARONE) TAB 200MG",2602600,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"COREG (CARVEDILOL) 12.5MG TABLET",2600108,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COREG (CARVEDILOL) 6.25MG TABLET",2602270,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CORGARD (NADOLOL) 20MG TABLET",2600091,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COUMADIN (WARFARIN) TAB 1MG",2602577,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COUMADIN (WARFARIN) TAB 2.5MG",2602584,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COUMADIN (WARFARIN) TAB 2MG",2602578,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COUMADIN (WARFARIN) TAB 5MG",2605059,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"COZAAR (LOSARTAN) TAB 50MG",2602545,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CRESTOR (ROSUVASTATIN) TAB 10MG",2602709,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"CYMBALTA (DULOXETINE) 30MG CAPSULE",2600080,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"DALMANE (FLURAZEPAM HCL) CAP : 15MG",2602107,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DANTRIUM (DANTROLENE NA) CAP 25MG",2602585,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DARVON 65 (PROPOXYPHENE HCL) CAP : 65MG",2602111,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DAYPRO (OXAPROZIN) TAB 600MG",2602729,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DECADRON (DEXAMETHASONE) ELX 0.5MG/5ML",2601285,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DEMADEX (TORSEMIDE) TAB 20MG",2602687,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DEPAKENE (VALPROIC ACID) LIQ 250MG/5ML",2660004,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DEPAKOTE (DIVALPROEX) 250MG TAB",2600414,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DEPAKOTE DR (DIVALPROEX DR) TAB 250MG",2602271,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DEPAKOTE SPRINKLE(DIVALPROEX) CAP 125MG",2605111,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DESYREL (TRAZODONE HCL) TAB 50MG",2602865,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DETROL (TOLTERODINE TART) TAB 1MG",2605006,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DETROL L.A. (TOLTERODINE) CAP 2MG",2605005,CDM,637,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"DEXAMETHASONE 4MG TABLET",2600047,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DIABETA (GLYBURIDE) TAB 5MG",2602645,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DIAMOX(ACETAZOLAMIDE) 250MG TAB",2602259,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DICLOXACILLIN 250MG CAPSULE",2600116,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DIFLUCAN (FLUCONAZOLE) TAB 100MG",2602594,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DILANTIN (PHENYTOIN SOD) CAP 100MG",2601302,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DILANTIN (PHENYTOIN) LIQ 100MG/4ML",2600818,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DILAUDID (HYDROMORPHONE) TAB  4MG",2601160,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DIOVAN (VALSARTAN) TAB 160MG",2603075,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DIOVAN (VALSARTAN) TAB 80MG",2605150,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DISALCID (SALSALATE) TAB 500MG",2602506,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DISALCID (SALSALATE) TAB 750MG",2603084,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DITROPAN (OXYBUTYNIN CHLORIDE) TAB 5MG",2602603,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DO NOT USE",2602252,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DULCOLAX (BISACODYL) SUPP 10MG",2600207,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"DULCOLAX (BISACODYL) TAB 5MG",2602614,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"EFFEXOR XR (VENLAFAXINE) CAP 37.5MG",2602523,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ELAVIL (AMITRIPTYLINE HCL) TAB 10MG",2602618,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELAVIL (AMITRIPTYLINE HCL) TAB 25MG",2602619,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELDEPRYL (SELEGILINE) TAB : 5MG",2605112,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ELIQUIS (APIXABAN) TAB 5MG",2602003,CDM,637,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"EQUANIL (MEPROBAMATE) TAB : 400MG",2602167,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ERYC (ERYTHROMYCIN) E.R. CAP 250MG",2602280,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ERY-TAB (ERYTHROMYCIN) BASE TAB 250MG",2600144,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ERY-TAB (ERYTHROMYCIN) BASE TAB 500MG",2602633,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ERYTHROMYCIN SUSP 400MG",2600716,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"EVISTA (RALOXIFINE) TAB 60MG",2605113,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"EXELON (RIVASTIGMINE) CAP 1.5MG",2605115,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"EXELON (RIVASTIGMINE) CAP 3MG",2605114,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"FAMVIR (FAMCICLOVIR) TAB 250MG",2600143,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"FAMVIR (FAMCICLOVIR) TAB 500MG",2602342,CDM,637,RC,,,OUTPATIENT,,,60,48,,51,85,,,,,0,"percent of total billed charges","85% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",15,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",33.9,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",21,35,,,,,0,"percent of total billed charges","35% of total billed charges",41.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",54,90,,,,,0,"percent of total billed charges","90% of total billed charges",34.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",12.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",51,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",12.22,54,
"FEOSOL (FERROUS SULF) TAB 325MG",2602636,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FEROSUL (FERROUS SULF) LIQ 220MG",2603065,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLAGYL (METRONIDAZOLE) TAB 250MG",2601170,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLEXERIL (CYCLOBENZAPRINE) TAB 10MG",2602640,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLOMAX (TAMSULOSIN) CAP 0.4MG",2603055,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"FLORINEF (FLUDROCORTISONE) TAB  0.1MG",2602200,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLUMADINE (RIMANTADINE HCL) TAB 100MG",2602272,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"FLUVOXAMINE (LUVOX) TAB 100MG",2602284,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"FOLIC ACID TAB 1MG",2602641,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GEODON (ZIPRASIDONE) CAP 20MG",2601320,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLUCOPHAGE (METFORMIN) ER TAB 500MG",263057,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLUCOPHAGE (METFORMIN) TAB 500MG",2603050,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLUCOPHAGE (METFORMIN) TAB 850MG",2605058,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLUCOTROL (GLIPIZIDE XL) TAB 10MG",2603026,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLUCOTROL (GLIPIZIDE XL) TAB 5MG",2602644,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLUCOTROL (GLIPIZIDE) TAB 5MG",2602643,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLYNASE (GLYBURIDE) TAB 3MG",2602646,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLYNASE (GLYBURIDE) TAB 6MG",2602707,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"HALDOL (HALOPERIDOL) TAB 1MG",2602647,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HALDOL (HALOPERIDOL) TAB 5MG",2602648,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HYDROCHLOROTHIAZIDE TAB 25MG",2602651,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HYGROTON (CHLORTHALIDONE) TAB 25MG",2602656,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HYTRIN (TERAZOSIN HCL) CAP 1MG",2602658,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"HYTRIN (TERAZOSIN HCL) CAP 5MG",2602661,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IMDUR (ISOSORBIDE MONONITRATE) TAB 30MG",2602677,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IMDUR (ISOSORBIDE MONONITRATE) TAB 60MG",2603083,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"IMITREX (SUMATRIPTAN) TAB 50MG",2601335,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IMODIUM (LOPERAMIDE HCL) CAP 2MG",2602660,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"INDERAL (PROPRANOLOL HCL) TAB 10MG",2602247,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"INDERAL (PROPRANOLOL HCL) TAB 40MG",2602248,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"INDERAL (PROPRANOLOL) TAB 20MG",2600125,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"INDERAL LA (PROPRANOLOL HCL) CAP 60MG",2602663,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"INDERAL LA (PROPRANOLOL HCL) CAP 80MG",2602249,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"INDOCIN (INDOMETHACIN) CAP 25MG",2602667,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ISMO (ISOSORBIDE MONONITRATE) TAB 20MG",2602676,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ISONIAZID TAB 300MG",2603029,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ISORDIL (ISOSORBIDE DINITRATE) TAB 10MG",2602678,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ISORDIL SR(ISOSORBIDE DINITRATE)TAB 40MG",2602250,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"JANUVIA (SITAGLIPTIN) 100MG TAB",262517,CDM,637,RC,,,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"KEFLEX (CEPHALEXIN) CAP 250MG",2602318,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KEFLEX (CEPHALEXIN) CAP 500MG",2602319,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KEFLEX (CEPHALEXIN) LIQ 125MG/5ML",2600718,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"KEFLEX (CEPHALEXIN) LIQ 250MG/5ML",2600719,CDM,637,RC,,,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",26.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",21.39,94.5,
"KEPPRA (LEVETIRACETAM) TAB 500MG",2611010,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"KLONOPIN (CLONAZEPAM) ODT  0.25MG",2603059,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KLONOPIN (CLONAZEPAM) TAB 0.5MG",2603054,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"K-PHOS(POT ACID PHOS) 500MG TAB",2600149,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LAMICTAL (LAMOTRIGINE) TAB 100MG",2601323,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LAMICTAL (LAMOTRIGINE) TAB 25MG",2601322,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LAMISIL (TERBINAFINE) TAB 250MG",2603069,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"LANOXICAP (DIGOXIN) CAP 0.1MG",2601342,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LANOXIN (DIGOXIN) ELX 0.25MG",2602685,CDM,637,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"LANOXIN (DIGOXIN) TAB 0.125MG",2600028,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LANOXIN (DIGOXIN) TAB 0.25MG",2600841,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LASIX (FUROSEMIDE) LIQ 10MG",2600842,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"LASIX (FUROSEMIDE) TAB 20MG",2602688,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LASIX (FUROSEMIDE) TAB 40MG",2602257,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEVAQUIN TAB 500MG",2603003,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LEVBID (HYOSCYAMINE ER) TAB 0.375MG",2603031,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LEVETIRACETAM (KEPPRA) SOLN 1,000MG/10ML",2611011,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEVSIN SL (HYOSCYAMINE) TAB 0.125MG",2602206,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEXAPRO (ESCITALOPRAM) TAB 10MG",2605187,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"LIBRIUM (CHLORDIAZEPOXIDE HCL) CAP 25MG",2602124,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LIBRIUM (CHLORDIAZEPOXIDE HCL) CAP 5MG",2602122,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LIBRIUM (CHLORDIAZEPOXIDE HCL)CAP 10MG",2602123,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LIBRIUM (CHLORDIAZEPOXIDE) CAP 25MG",2610171,CDM,637,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"LIPITOR (ATORVASTATIN CA) TAB 10MG",2602273,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"LIPITOR (ATORVASTATIN CA) TAB 20MG",2603087,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"LITHIUM CARBONATE 150MG CAPSULE",2600112,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LITHIUM CARBONATE CAP 300MG",2602691,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LODINE (ETODOLAC) CAP 300MG",2602216,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LODINE (ETODOLAC) TAB 400MG",2602732,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LOMOTIL(DIPHENOXYLATE/ATROPINE)LIQ 2.5MG",2600609,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LOPID (GEMFIBROZIL) TAB 600MG",2602692,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LOPRESSOR (METOPROLOL TARTRATE) TAB 25MG",2610177,CDM,637,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"LOPRESSOR (METOPROLOL TARTRATE) TAB 50MG",2602693,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LOTENSIN (BENAZEPRIL HCL) TAB 10MG",2602695,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LOZOL (INDAPAMIDE) TAB 1.25MG",2602701,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"LYRICA (PREGABALIN) CAP 50MG",2660011,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LYRICA (PREGABALIN) CAP 75MG",2660009,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MACROBID (NITROFURANTOIN) CAP 100MG",2602322,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MAGNESIUM OXIDE TAB 400MG",2602697,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MEDROL DP (METHYLPREDNISOLONE) TAB 4MG",2601395,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"MEGACE (MEGESTROL ACET) TAB 40MG",2605068,CDM,637,RC,S0179,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MEGACE (MEGESTROL) 400MG/10ML",2605035,CDM,637,RC,S0179,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"MELATONIN CAP 10MG",2610137,CDM,637,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"MELLARIL (THIORIDAZINE HCL) TAB 10MG",2602702,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MELLARIL (THIORIDAZINE HCL) TAB 15MG",2602713,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"MELLARIL (THIORIDAZINE HCL) TAB 25MG",2602712,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"METHADONE TAB 10MG",2605135,CDM,637,RC,S0109,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"METHOTREXATE TAB 2.5MG",2602202,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"METHYLERGONOVINE 0.2MG TABLET",2600003,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MEVACOR (LOVASTATIN) TAB 20MG",2602705,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"MICARDIS (TELMISARTAN) TAB 40 MG",2615151,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MICARDIS (TELMISARTAN) TAB 80 MG",2600153,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MICROZIDE(HYDROCHLOROTHIAZIDE)CAP 12.5MG",2605155,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MIDODRINE HCL TAB 5MG",2610176,CDM,637,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"MINOXIDIL 2.5MG TABLET",2600031,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MOBIC (MELOXICAM) TAB 7.5MG",2602723,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MORPHINE 10MG/5ML UNIT DOSE CUP",2600131,CDM,637,RC,J2270,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.51,120.37,,4.71,4.17,5.25,"1 through 10","fee schedule","120.37% of GA fee schedule",8.48,56.5,,32.34,14.03,285.47,"1 through 10","percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.73,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.51,120.37,,5.09,5.09,5.11,"1 through 10","fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.75,13.5,
"MOTRIN (IBUPROFEN) 100MG/5ML SUSP 5ML",2600892,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MOTRIN (IBUPROFEN) TAB 400MG",2602721,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MOTRIN (IBUPROFEN) TAB 600MG",2602722,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MS CONTIN (MORPHINE SULF CR) TAB 15MG",2602005,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MS CONTIN (MORPHINE SULF CR) TAB 30MG",2605028,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MS CONTIN (MORPHINE SULF CR) TAB 60MG",2605127,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"MUCINEX (GUAIFENESIN) TAB 600MG",2602800,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MYCELEX (CLOTRIMAZOLE) TROCHE 10MG",2602251,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MYLICON (SIMETHICONE) CHEW TAB 80MG",2603061,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MYSOLINE (PRIMIDONE) TAB 50MG",2602201,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NAC (N-ACETYL-CYSTEINE) CAP 600MG",2601324,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NAMENDA (MEMANTINE) TAB 10MG",260008,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NAPROSYN (NAPROXEN) TAB 250MG",2602731,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NAVANE (THIOTHIXENE) CAP 1MG",2602735,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NAVANE (THIOTHIXENE) CAP 5MG",2602737,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NEOMYCIN TAB 500MG",2605085,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NEURONTIN (GABAPENTIN) CAP 100MG",2603058,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEURONTIN (GABAPENTIN) CAP 300MG",2605107,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEURONTIN (GABAPENTIN) CAP 400MG",2600146,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-BUSPAR (BUSPIRONE HCL) TAB 10MG",2603027,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-BUSPAR (BUSPIRONE HCL) TAB 5MG",2602540,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-CARDIZEM (DILTIAZEM CD) CAP 360MG",2602239,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NF-CEDAX (CEFTIBUTEN) 90MG/5ML SUSP",2603060,CDM,637,RC,,,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",67.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",55,243,
"NF-MYSOLINE (PRIMIDONE) TAB : 250MG",2603045,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-PEDIAPRED (PREDNISOLONE) LIQ 5MG/5ML",2602765,CDM,637,RC,J7510,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-PYRIDIUM (PHENAZOPYRIDINE) TAB 200MG",2603089,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-STERAPRED (DOSEPAK) TAB : 5MG",2602777,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NF-STERAPRED DS DOSEPAK 10MG",2602778,CDM,637,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"NF-TEQUIN (GATIFLOXACIN) TAB : 200MG",2605078,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"NF-TEQUIN (GATIFLOXACIN) TAB : 400MG",2605052,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"NF-ZANTAC (RANITIDINE) TAB : 150MG",2602878,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NICODERM (NICOTINE) PATCH 14MG",2605076,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NICODERM (NICOTINE) PATCH 21MG",2600444,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NICOTINE PATCH 7MG",2600006,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NIFEREX (IRON COMPLEX) LIQ 100MG",2602282,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NITROGLYCERIN 0.1MG PATCH",2600445,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NITROGLYCERIN 0.2MG PATCH",2600446,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NITROGLYCERIN 0.4MG PATCH",2600447,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NITROSTAT (NITRO) SL TAB  0.4MG",2602745,CDM,637,RC,,,OUTPATIENT,,,5,4,,4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1.02,4.5,
"NITROSTAT (NITRO) SL TAB USE 0.4MG",2605087,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NIZORAL (KETOCONAZOLE) TAB 200MG",2602741,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NOLVADEX (TAMOXIFEN CITRATE) TAB 10MG",2602739,CDM,637,RC,S0187,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NORMODYNE (LABETALOL HCL) TAB 100MG",2603012,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NORVASC (AMLODIPINE) TAB 5MG",2602752,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OMNICEF (CEFDINIR) CAP 300MG",2605090,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"OMNICEF SUSP 125MG/5ML",2605091,CDM,637,RC,,,OUTPATIENT,,,360,288,,306,85,,,,,0,"percent of total billed charges","85% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",90,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",203.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",126,35,,,,,0,"percent of total billed charges","35% of total billed charges",247.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",324,90,,,,,0,"percent of total billed charges","90% of total billed charges",208.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",73.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",306,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",73.33,324,
"OPANA ER (OXYMORPHONE ER) TAB 5MG",2602015,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"OSCAL (OYSTER SHELL CALCIUM) TAB 500MG",2602756,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OXCARBAZEPINE (TRILEPTAL) TAB 300MG",2602274,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"OXYCODONE (OXYCODONE IR) TAB 5MG",2605051,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OXYCODONE (OXYCODONE) I.R. 20MG TAB",2600168,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OXYCONTIN (OXYCODONE CR) TAB 10MG",2602013,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"OXYCONTIN (OXYCODONE CR) TAB 40MG",2602014,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PAMELOR (NORTRIPTYLINE HCL) CAP 10MG",2600056,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PAMELOR (NORTRIPTYLINE HCL) CAP 25MG",2600078,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PAXIL (PAROXETINE HCL) TAB 20MG",2600060,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PAXIL CR (PAROXETINE) TAB 12.5MG",2600007,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PENICILLIN VK TAB 250MG",2602213,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PEPCID (FAMOTIDINE) TAB 20MG",2602762,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PERCOCET (OXYCODONE/APAP) TAB 5MG",2602012,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PERIACTIN (CYPROHEPTADINE HCL) TAB 4MG",2602764,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PERSANTINE  (DIPYRIDAMOLE) TAB 25MG",2602768,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PHAZYME (SIMETHICONE) CAP 180MG",2602727,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PHENERGAN (PROMETHAZINE HCL) SUPP 25MG",2600863,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PHENERGAN (PROMETHAZINE HCL) TAB 25MG",2601371,CDM,637,RC,Q0169,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PHENERGAN (PROMETHAZINE) LIQ 6.25MG",2600210,CDM,637,RC,Q0169,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PHENERGAN (PROMETHAZINE) SUPP 12.5MG",2600218,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"PHENERGAN (PROMETHAZINE) W/ CODEINE LIQ",2600211,CDM,637,RC,Q0169,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PHENOBARB (PHENOBARBITAL) ELX 20MG/5ML",2600616,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PHENOBARB (PHENOBARBITAL) TAB 32.4MG",2602131,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PHOS-LO (CALCIUM ACETATE) CAP 667MG",2605079,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PLAQUENIL (HYDROXYCHLOROQUINE)TAB 200MG",2605008,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PLAVIX (CLOPIDOGREL BISULFATE) TAB 75MG",2602773,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PLENDIL (FELODIPINE) TAB 2.5MG",2600110,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PLETAL (CILOSTAZOL) TAB 100MG",2605148,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PRAMIPEXOLE 0.5MG TAB",2600126,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PRANDIN (REPAGLINIDE) TAB 1MG",2603074,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PRAVACHOL (PRAVASTATIN) TAB 20MG",2605138,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PRECOSE (ACARBOSE) TAB 50MG",2602771,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PREDNISONE TAB 1 MG",2602775,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PREDNISONE TAB 10MG",2602776,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PREDNISONE TAB 20MG",2603011,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PREDNISONE TAB 5MG",2602774,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PRELONE SYRUP 15MG/5ML",2603001,CDM,637,RC,J7510,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PREMARIN (ESTROGEN CONJ) TAB 0.625MG",2602780,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PREVACID (LANSOPRAZOLE) CAP 15MG",2602699,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"PREVACID (LANSOPRAZOLE) SOLUTAB 30MG",2605189,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"PRILOSEC (OMEPRAZOLE) CAPSULE 20MG",2602694,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PROCARDIA (NIFEDIPINE) CAP 10MG",2602784,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PROMETHAZINE GEL 25MG/0.5ML",2600864,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"PROSCAR (FINASTERIDE) TAB 5MG",2601432,CDM,637,RC,S0138,HCPCS,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PROTONIX (PANTOPRAZOLE) TAB 40MG",2605175,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PROVERA (MEDROXYPROGESTERONE) TAB 10MG",2601291,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"PROZAC (FLUOXETINE) CAP 10MG",2600066,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PROZAC (FLUOXETINE) CAP 20MG",2602221,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"PYRAZINAMIDE TABLET 500MG",2605105,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PYRIDIUM (PHENAZOPYRIDINE) TAB 100MG",2602789,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"QUINAGLUTE (QUINIDINE GLUC) TAB 324MG",2602793,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"QUINAMM (QUININE SULF) TAB 260MG",2602794,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"QUINIDINE SULF TAB 200MG",2602796,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"RAZADYNE(GALANTAMINE) 8MG",262513,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RAZADYNE(GALANTAMINE) 8MG",2600136,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"REGLAN (METOCLOPRAMIDE HCL) TAB 10MG",2602799,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"REGLAN (METOCLOPRAMIDE) LIQ 5MG/5ML",2600865,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RELAFEN (NABUMETONE) TAB 750MG",2602730,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"REMERON (MIRTAZAPINE) TAB 15MG",2605100,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"REQUIP (ROPINIROLE) 0.5MG TABLET",2600063,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"RESTORIL (TEMAZEPAM) CAP 15MG",2602134,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RESTORIL (TEMAZEPAM) CAP 30MG",2602135,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"RIFAMPIN CAPSULE 300MG",2603030,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"RISPERDAL (RISPERIDONE) TAB 0.5MG",2602277,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"RISPERDAL (RISPERIDONE) TAB 1MG",2605123,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"RISPERDAL (RISPERIDONE) TAB 1MG",2660013,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RITALIN (METHYLPHENIDATE HCL) TAB 5MG",2602008,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ROBAXIN (METHOCARBAMOL) TAB 500MG",2601341,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROBAXIN (METHOCARBAMOL) TAB 750MG",2601346,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ROXANOL (MORPHINE SULF) CONC LIQ 20MG",2603072,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROXICODONE (OXYCODONE I.R.) 15MG TABLET",2600130,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROZEREM (RAMELTEON) 8MG TABLET",2600107,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"RYTHMOL (PROPAFENONE) TAB 150MG",2605104,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SECONAL (SECOBARBITAL) CAP 100MG",2602011,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SEROQUEL (QUETIAPINE) TAB 100MG",2605177,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"SEROQUEL (QUETIAPINE) TAB 25MG",2660012,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"SINEQUAN (DOXEPIN HCL) CAP 10MG",2602244,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SINEQUAN (DOXEPIN HCL) CAP 25MG",2602814,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SINGULAIR (MONTELUKAST) CHEW TAB 5MG",2605118,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SINGULAIR (MONTELUKAST) TAB 10MG",2605037,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"SKELAXIN (METAXALONE) TAB 800MG",2605159,CDM,637,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"SLO-NIACIN 500MG CR TABLET",2600128,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SOD BICARB 10 GRAINS TAB 650MG",2602207,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SODIUM CHLORIDE TABLET 1000MG",2699995,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SOMA (CARISOPRODOL) TAB 350MG",2602639,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUDAFED (PSEUDOEPHEDRINE HCL) TAB 30MG",2602823,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SUDAFED PE (PHENYLEPHRINE HCL) 10MG",2600152,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SYMMETREL (AMANTADINE) CAP 100MG",2602826,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TALWIN NX (PENTAZOCINE/NALOXONE)TAB 50MG",2602140,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TAMBOCOR (FLECAINIDE ACETATE) TAB 50MG",2602832,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TAMIFLU (OSELTAMIVIR PHOS) CAP 30MG",2605027,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"TAMIFLU (OSELTAMIVIR PHOS) CAP 45MG",2605026,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"TAMIFLU (OSELTAMIVIR PHOS) CAP 75MG",2605025,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"TAMIFLU (OSELTAMIVIR) 6MG/1ML 60ML BTL",2600085,CDM,637,RC,,,OUTPATIENT,,,305,244,,259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",76.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",172.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",106.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",209.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",274.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",62.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",259.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",62.13,274.5,
"TAPAZOLE(METHIMAZOLE) 5MG TAB",2600137,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TAVIST (CLEMASTINE FUMERATE) TAB 2.68MG",2605060,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TEGRETOL (CARBAMAZEPINE) TAB 200MG",2602834,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TENORMIN (ATENOLOL) TAB 25MG",2602836,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TENORMIN (ATENOLOL) TAB 50MG",2602838,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TESSALON (BENZONATATE) CAP 100MG",2602835,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TETRACYCLINE CAP : 250MG",2602325,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"THEO-DUR (THEOPHYLLINE SA) TAB 200MG",2602840,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"THEO-DUR (THEOPHYLLINE SA) TAB 300MG",2602839,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"THORAZINE (CHLORPROMAZINE HCL) TAB 25MG",2601407,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"THORAZINE (CHLORPROMAZINE) TAB 100MG",2602846,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"THYROID TAB : 60MG",2602848,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TICLID (TICLOPIDINE) TAB 250MG",2602850,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TIGAN (TRIMETHOBENZAMIDE) CAP 300MG",2602849,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TIGAN (TRIMETHOBENZAMIDE) SUPP 100MG",2600214,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TIGAN (TRIMETHOBENZAMIDE) SUPP 200MG",2600213,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TOPAMAX (TOPIRAMATE) TAB 100MG",2600127,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"TOPAMAX (TOPIRAMATE) TAB 25MG",2600122,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TOPROL XL (METOPROLOL SUCC) TAB 50MG",2603064,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TORADOL (KETORALAC) TAB 10MG",2602855,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRANS-SCOP (SCOPOLAMINE) PATCH 1 MG",2605082,CDM,637,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"TRANXENE (CLORAZEPATE DIPOT) TAB 7.5MG",2602142,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRENTAL (PENTOXIFYLLINE) TAB 400MG",2602857,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRIAVIL(PERH/AMITR)2/25MG TAB",2600139,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRICOR (FENOFIBRATE) TAB 160MG",2605106,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"TRILAFON (PERPHENAZINE) TAB 2MG",2602860,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TUMS (CALCIUM CARBONATE) CHW TAB 500MG",2602254,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) DRP 100MG",2600215,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) LIQ 160MG",2600885,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) SUPP 120MG",2600216,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) SUPP 325MG",2600217,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) SUPP 650MG",2602863,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) TAB 325MG",2602223,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TYLENOL (ACETAMINOPHEN) TAB 500MG",2606002,CDM,637,RC,,,OUTPATIENT,,,10,8,,8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",2.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",5.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",3.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",6.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",2.04,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2.04,9,
"TYLENOL (ACETAMINOPHEN) UD LIQ 160MG",2600889,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL (ACETAMINOPHEN) UD LIQ 325MG",2603085,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL PED DROPS 100MG/1ML 15ML",2600888,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ULORIC(FEBUXOSTAT)80MG TAB",2600140,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ULTRAM (TRAMADOL) TAB 50MG",2602868,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"UNIPHYL (THEOPHYLLINE CR) TAB 400MG",2602253,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"URISPAS (FLAVOXATE HCL) TAB 100MG",2602867,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VALIUM (DIAZEPAM) TAB 2MG",2601190,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VALIUM (DIAZEPAM) TAB 5MG",2602147,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VALTREX (VALCYCLOVIR HCL) TAB 500MG",2605077,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"VANCOCIN (VANCOMYCIN HCL) CAP 125MG",2602328,CDM,637,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"VANCOMYCIN ORAL SOLN : 250MG/5ML BOTTLE",2601417,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"VASOTEC (ENALAPRIL MALEATE) TAB 10MG",2600075,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VASOTEC (ENALAPRIL MALEATE) TAB 5MG",2600069,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"VIBRATAB (DOXYCYCLINE ) TAB 100MG",2602327,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VISTARIL (HYDROXYZINE PAMOATE) CAP 25MG",2602873,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VITAMIN B-1 (THIAMINE HCL) TAB 100MG",2601405,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VITAMIN B6 (PYRIDOXINE HCL) TAB 50MG",2605161,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VITAMIN C (ASCORBIC ACID) TAB 500MG",2606003,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VOLTAREN (DICLOFENAC SOD) TAB 50MG",2605185,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"VOLTAREN (DICLOFENAC SOD) TAB 75MG",2605186,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VOSPIRE (ALBUTEROL E.R.) TAB 4MG",2602285,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"WELCHOL (COLESEVELAM) TAB 625MG",2602792,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"WELLBUTRIN SR (BUPROPION) TAB 100MG",2605179,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"WELLBUTRIN XL (BUPROPION) TAB 150MG",2602279,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"XANAX (ALPRAZOLAM) TAB : 0.5MG",2602151,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"XANAX (ALPRAZOLAM) TAB 0.25MG",2602150,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XANAX (ALPRAZOLAM) TAB 1MG",2602152,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XARELTO (RIVAROXABAN) TAB 10MG",2662785,CDM,637,RC,A9270,HCPCS,OUTPATIENT,,,50,40,,42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",12.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",28.25,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",28.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",34.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",45,90,,,,,0,"percent of total billed charges","90% of total billed charges",29,58,,,,,0,"percent of total billed charges","58% of total billed charges",10.19,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",42.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",10.19,45,
"ZANAFLEX (TIZANIDINE) TAB 2MG",2605154,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZANAFLEX (TIZANIDINE) TAB 4MG",2600142,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZANTAC (RANITIDINE) LIQ 150MG/10ML",2602233,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZANTAC (RANITIDINE) TAB 75MG",2662787,CDM,637,RC,A9270,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,10.97,10.97,10.97,"1 through 10","percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZAROXOLYN (METOLAZONE) TAB 2.5MG",2600090,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZAROXOLYN (METOLAZONE) TAB 5MG",2602879,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZESTRIL (LISINOPRIL) TAB 10MG",2600067,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZESTRIL (LISINOPRIL) TAB 5MG",2600068,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZIAC (BISOPROLOL FUM/HCTZ) TAB 10MG",2602243,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZIAC (BISOPROLOL FUM/HCTZ) TAB 2.5MG",2602242,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZIAC (BISOPROLOL FUM/HCTZ) TAB 5MG",2602286,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZINC 50MG TAB",2600138,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZITHROMAX (AZITHROMYCIN) TAB 250MG",2602332,CDM,637,RC,Q0144,HCPCS,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ZITHROMAX SUSP 100MG/5ML 15ML",2602291,CDM,637,RC,Q0144,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"ZOCOR (SIMVASTATIN) TAB 10MG",2602703,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZOCOR (SIMVASTATIN) TAB 20MG",2602704,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZOFRAN (ONDANSETRON HCL) TAB 4MG ODT",2605167,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZOLOFT (SERTRALINE HCL) TAB 50MG",2602866,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ZOVIRAX (ACYCLOVIR) TAB 400MG",2602331,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ZYLOPRIM (ALLOPURINOL) TAB 100MG",2602287,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZYLOPRIM (ALLOPURINOL) TAB 300MG",2602882,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZYPREXA (OLANZAPINE) TAB 10MG",2610119,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZYPREXA (OLANZAPINE) TAB 2.5MG",2605074,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ZYPREXA (OLANZAPINE) TAB 5MG",2605075,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"ZYPREXA (OLANZAPINE) TAB 5MG",2610118,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ZYRTEC (CETIRIZINE) TAB 10MG",2605039,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"ACCUHIST DM DROPS (BR/DM/PSE) : 30ML",2660005,CDM,637,RC,,,OUTPATIENT,,,145,116,,123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",36.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",81.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",50.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",99.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",84.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",29.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",123.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",29.54,130.5,
"ATUSS DM (CPM/PE/DM) LIQ : 5ML",2603057,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ATUSS HD (CPM/PE/HD) LIQ : 5ML",2603035,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ATUSS MS (CPM/PE/HD) LIQ : 5ML",2603036,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"BACTRIM (SMZ/TMP) 200MG/40MG SUSP 5ML",2600710,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BICITRA (ORACIT) SOLUTION 30ML UD",2602340,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BICITRA (ORACIT) SOLUTION 480ML",2602341,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CASCARA ORAL SOLUTION : 5ML",2600809,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"CHRONULAC (LACTULOSE) LIQ 30ML",2605098,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"CODICLEAR (HYDROCOD/GUAIFENESIN) LIQ:5ML",2605120,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DONNATAL (PHENOBARB/BELLADONNA) ELX 5ML",2600876,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ED A-HIST (CPM/PHENYLEPHRINE) LIQ 5ML",2600871,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ELDERTONIC (VITAMIN TONIC) LIQ 15ML",2600882,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ENDAL HD (CPM/PE/HD) LIQ : 5ML",2603033,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"FEOSOL DR (FERROUS SULF) DRP 1ML",2600829,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"FLEET ENEMA (SOD PHOS/SOD BIPHOS) 120ML",2600256,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLEET PED ENEMA(SOD PHOS/SOD BIPHO) 60ML",2600257,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLEET PHOSPHA SODA  LIQ  45ML",2600830,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"GI COCKTAIL(MAALOX+LEVSIN) LIQ 30 ML",2600833,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"IMODIUM (LOPERAMIDE) LIQ 5ML",2603062,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"IPECAC SYRUP ORAL 30ML",2600836,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"KAOPECTATE (BIS.SUB.SAL.) SUSP 30ML",2600846,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LEVSIN (HYOSCYAMINE) 0.125MG/5ML  ELIXIR",2603014,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LORTAB(HYDROCODONE/ACET) 7.5/15ML",2600614,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MAALOX (AL/MG HYDROXIDE) SUSP 30ML",2600847,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MAGIC MOUTHWASH LIQ 5ML",2602212,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MAGNESIUM CITRATE LIQ 300ML",2600849,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MIDAZOLAM (VERSED) SYRUP 10MG/5ML",2660003,CDM,637,RC,,,OUTPATIENT,,,65,52,,55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.66,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",55.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.24,58.5,
"MILK OF MAGNESIA LIQ 30ML",2600852,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MINERAL OIL LIQ 30ML",2600853,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-ATUSS EX (GUAICOSULFATE/HD) SYRUP 5ML",2603039,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-ATUSS G (GUAIFENESIN/PE/HD) 5ML",2603037,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-MAALOX EX (MG/AL OH SIMETH)SUS:30ML",2600848,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-PERI-COLACE (DOCUSATE/CASS) LIQ 5ML",2602761,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NFRONDEC DM (CARBINOXAMINE/PSE/DM) DROPS",2600872,CDM,637,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"NOHIST-DM (CPM/DM/PHENYLEPHRINE) LIQ 5ML",2600873,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NON-FORM BOTTLE LIQ",2602230,CDM,637,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"NON-FORM DOSE LIQ : 5ML",2600096,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NON-FORM NUTRITIONAL LIQ : 1ML",2620000,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"NON-FORMULARY ABX LIQ : 1ML",2609505,CDM,637,RC,,,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,639,
"NYSTATIN LIQ 5ML",2605024,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NYSTATIN ORAL LIQ 60ML",2600722,CDM,637,RC,,,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"OIL OF CLOVE 3.7ML",2605021,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"PEDIAZOLE (ERY/SULFISOXAZOLE)SUSP:100ML",2600724,CDM,637,RC,,,OUTPATIENT,,,85,68,,72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",21.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",48.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",29.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",58.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",76.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",49.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",17.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",72.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",17.31,76.5,
"PEPTO-BISMOL (BISMUTH SUBSALIC)SUSP 30ML",2603073,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROBITUSSIN (GUAIFENESIN) 100MG/5ML",2600868,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROBITUSSIN AC (GUAIF 100MG/COD 10MG) 5ML",2600132,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROBITUSSIN DM (GUAIFENESIN/DM) LIQ 10ML",2600869,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROXICET (OXYCODONE/APAP) LIQ 5ML",2600604,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"RYNATAN (CPM/PENYL TANNATE) LIQ 5ML",2605097,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"SORBITOL 70% LIQ 30ML",2605019,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SWEET-EASE (SUCROSE) SOLUTION : 11ML",2605151,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"THERAGRAN (MULTIVITAMIN) LIQ 5ML",2600880,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"TUSSIONEX (HYDROCODONE/CPM) LIQ 5ML",2600624,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"TYLENOL/CODEINE  ELIX 120MG/12MG 5ML",2600625,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"XYLOCAINE 2% (LIDOCAINE) VISCOUS 15ML",2600891,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"METAMUCIL (PSYLLIUM) SF ORNG PKT",2602706,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NEUTRAPHOS PACKET",2605168,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NITROL (NITROGLYCERIN) PKT OINT",2605102,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VASELINE (PETROLEUM JELLY) PKT OINT",2603022,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CATAPRES-TTS-1 (CLONIDINE TTS-1) PATCH",2602224,CDM,637,RC,,,OUTPATIENT,,,130,104,,110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",32.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",73.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",45.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",89.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",117,90,,,,,0,"percent of total billed charges","90% of total billed charges",75.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",26.48,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",110.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",26.48,117,
"LIDODERM (LIDOCAINE) 5% PATCH",2660014,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"FLOVENT (FLUTICASONE) 110MCG MDI",2600054,CDM,637,RC,,,OUTPATIENT,,,820,656,,697,85,,,,,0,"percent of total billed charges","85% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",205,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",463.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",287,35,,,,,0,"percent of total billed charges","35% of total billed charges",563.34,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",738,90,,,,,0,"percent of total billed charges","90% of total billed charges",475.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",167.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",697,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",167.03,738,
"AFRIN (OXYMETAZOLINE HCL) NASAL SPRAY",2602204,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ASTELIN NASAL 137MCG/SPRAY (30ML)",2600123,CDM,637,RC,,,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"BENZOIN TINCTURE SPRAY",2600403,CDM,637,RC,,,OUTPATIENT,,,70,56,,59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",17.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",39.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",24.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",48.09,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",63,90,,,,,0,"percent of total billed charges","90% of total billed charges",40.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",14.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",59.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",14.26,63,
"CETACAINE (BENZO/TETRACAINE) SPRAY",2600409,CDM,637,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"CETACAINE (BENZO/TETRACAINE) SPRAY 1 USE",2600410,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CHLORASEPTIC (PHENOL) 1.4% SPRAY",2603032,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"DERMOPLAST (BENZOCAINE/MENTHOL) SPRAY",2600074,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"FLONASE (FLUTICASONE) NASAL SPRAY",2605031,CDM,637,RC,,,OUTPATIENT,,,385,308,,327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",96.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",217.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",134.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",264.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",346.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",223.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",78.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",327.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",78.42,346.5,
"GRANULEX (TBC SPRAY BOTTLE)",2600423,CDM,637,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"HURRICAINE (BENZOCAINE) 20% SPRAY",2602552,CDM,637,RC,,,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",51.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",140.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",41.76,184.5,
"MIACALCIN (CALCITONIN) NASAL SPRAY",2605036,CDM,637,RC,,,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"NASACORT AQ (TRIAMCINOLONE) NASAL SPRAY",2605054,CDM,637,RC,,,OUTPATIENT,,,420,336,,357,85,,,,,0,"percent of total billed charges","85% of total billed charges",105,25,,,,,0,"percent of total billed charges","25% of total billed charges",105,25,,,,,0,"percent of total billed charges","25% of total billed charges",105,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",237.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",378,90,,,,,0,"percent of total billed charges","90% of total billed charges",147,35,,,,,0,"percent of total billed charges","35% of total billed charges",288.54,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",378,90,,,,,0,"percent of total billed charges","90% of total billed charges",243.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",85.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",357,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.55,378,
"NEO-SYNEPHRINE 0.25%(PHENYLEPHRINE)SPRAY",2600165,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NEO-SYNEPHRINE 0.5%(PHENYLEPHRINE)SPRAY",2600160,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"NEO-SYNEPHRINE 1% (PHENYLEPHRINE) SPRAY",2600161,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"NITROLINGUAL (NITRO) SPR",2603081,CDM,637,RC,,,OUTPATIENT,,,465,372,,395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",116.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",262.73,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",162.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",319.46,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",418.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",269.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",94.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",395.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",94.72,418.5,
"SALINE (SODIUM CL) NASAL SPRAY 45ML",2600164,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CERVIDIL (DINOPROSTONE) VAG SUPP",2600206,CDM,637,RC,,,OUTPATIENT,,,1355,1084,,1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",338.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",474.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",930.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",785.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",276.01,1219.5,
"GLYCERIN (ADULT) SUPP",2600208,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"GLYCERIN (CHILD) SUPP",2600209,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"BACTRIM DS (TMP/SMZ) 160/800 TAB",2602307,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CLARITIN-D 12HR (LORATADINE/PSE) TAB",2602558,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DA CHEWAB (CMP/PE/METHSCOP) TAB",2605108,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DARVOCET-N-100(PROPOXY/ACE)100/650MG TAB",2602109,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DONNATAL (BELLADONNA ALK/PB) TAB",2602608,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"DYAZIDE (HCTZ/TRIAMTERENE) TAB",2602616,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ESGIC (ACET/CAFF/BUTALBITAL) TAB",2600033,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ESTRATEST (EEMT DS) TAB 1.25/2.5MG",2605156,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"ESTRATEST (EEMT HS) TAB 0.625/1.25MG",2605157,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"HYZAAR (LOSARTAN/HCT) 50-12.5MG TAB",2602653,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"LOMOTIL(DIPHENOXYLATE/ATROPINE)TAB 2.5MG",2602127,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LORCET-10 (HYDROCODONE/ACET) TAB",2602115,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LORCET-5/325MG(HYDROCODONE/ACET) TAB",2602117,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"LORCET-7.5 (HYDROCODONE/ACET) TAB",2602116,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MUCINEX DM (GUAIFENESIN DM) TAB",2602801,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MUCINEX-D (GUAIFEN/PSE 600/60) TAB",2602806,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-ALDACTAZIDE TAB 25MG/25MG",2602501,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NF-CORRECTOL (BISACODYL) TAB",2602613,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PERI-COLACE (DOCUSATE/SENNA) TAB",2602763,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SENOKOT (SENNA) TAB",2603066,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SINEMET (CARBIDOPA/LEVODOPA) 10/100 TAB",2602816,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"SINEMET (CARBIDOPA/LEVODOPA) 25/100 TAB",2602815,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TYLENOL #3 TAB : 300MG/30MG",2602145,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"VICOPROFEN 7.5 (HYDROCODONE/IBUPROFEN)",2602118,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"VITAMIN K (MEPHYTON) 5MG TAB",2600191,CDM,637,RC,,,OUTPATIENT,,,40,32,,34,85,,,,,0,"percent of total billed charges","85% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",10,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",22.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",14,35,,,,,0,"percent of total billed charges","35% of total billed charges",27.48,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",36,90,,,,,0,"percent of total billed charges","90% of total billed charges",23.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",8.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",34,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",8.15,36,
"BACTRIM SS (SMP/TMP) TAB 80/400MG",2602311,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"CEPHADYN (BUTALBUTAL/APAP) 50/325",2600134,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"MULTIVITAMIN TAB",2602841,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"PROLEX-D (GUAIFEN/PHENYLEPH 600/20) TAB",2602807,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"VITAMIN E (TOCOPHEROL) CAP 400 UNIT",2606004,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NOVOLIN R (INSULIN HUMAN-R) INJ PER UNIT",2603082,CDM,637,RC,,,OUTPATIENT,,,1,0.8,,0.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",0.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",0.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.35,35,,,,,0,"percent of total billed charges","35% of total billed charges",0.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.58,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.2,0.9,
"HUMALOG 75/25 KWIKPEN",2605122,CDM,637,RC,J1817,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"HUMALOG KWIKPEN",2605049,CDM,637,RC,S5551,HCPCS,OUTPATIENT,,,100,80,,85,85,,,,,0,"percent of total billed charges","85% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",56.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",35,35,,,,,0,"percent of total billed charges","35% of total billed charges",68.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",90,90,,,,,0,"percent of total billed charges","90% of total billed charges",58,58,,,,,0,"percent of total billed charges","58% of total billed charges",20.37,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",20.37,90,
"HUMULIN N KWIKPEN",2601436,CDM,637,RC,J1817,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"LANTUS (INSULIN GLARGINE) 100UNITS/1ML",2605089,CDM,637,RC,J1815,HCPCS,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,13.5,
"LANTUS INJ PER UNIT",2605080,CDM,637,RC,J1815,HCPCS,OUTPATIENT,,,1,0.8,,0.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",0.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",0.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",0.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",0.57,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",0.57,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.28,125.18,,,,,0,"fee schedule","125.18% of GA fee schedule",0.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.9,90,,,,,0,"percent of total billed charges","90% of total billed charges",0.58,58,,,,,0,"percent of total billed charges","58% of total billed charges",0.26,120.37,,,,,0,"fee schedule","120.37% of GA fee schedule",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",0.85,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",0.25,0.9,
"THROMBIN TOPICAL 5,000 UNITS",2605013,CDM,637,RC,,,OUTPATIENT,,,405,324,,344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",101.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",228.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",141.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",278.24,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",364.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",234.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",82.5,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",344.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",82.5,364.5,
"BETADINE (POVIDINE/IODINE) 5% OPHT",2600038,CDM,637,RC,,,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"CORTISPOR (NEOMYCIN/POLY/CORT) EYE OINT",2600104,CDM,637,RC,,,OUTPATIENT,,,95,76,,80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",23.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",53.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",33.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",65.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",85.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",55.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",19.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",80.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",19.35,85.5,
"CORTISPOR (NEOMYCIN/POLY/CORT) EYE SUSP",2600307,CDM,637,RC,,,OUTPATIENT,,,300,240,,255,85,,,,,0,"percent of total billed charges","85% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",105,35,,,,,0,"percent of total billed charges","35% of total billed charges",206.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",174,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",255,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",61.11,270,
"CORTISPORIN TC OTIC SUSP 5ML",2600306,CDM,637,RC,,,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",42.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",34.63,153,
"DIPROSONE (BETAMETHASONE) 0.05% OINT",2605073,CDM,637,RC,,,OUTPATIENT,,,45,36,,38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",11.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",25.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",15.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",30.92,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",26.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",9.17,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",38.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",9.17,40.5,
"DUOVISC (PROVISC/VISCOTE) EA",2602575,CDM,637,RC,,,OUTPATIENT,,,1300,1040,,1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",325,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",455,35,,,,,0,"percent of total billed charges","35% of total billed charges",893.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",754,58,,,,,0,"percent of total billed charges","58% of total billed charges",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",264.81,1170,
"FIBERCON (POLYCARBOPHIL CALCIUM) TAB",2602281,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"FLEET PREP #1 (BISACODYL/SOD PHOS) KIT",2605003,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"GARAMYCIN (GENTAMICIN SULF) OPHTH OINT",2601022,CDM,637,RC,,,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"GENTIAN VIOLET 1% : 2OZ",2660010,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"MESCOLOR (CPM/PSE/METHSCOPOLAM) TAB",2603028,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NEOSPORIN (NEOMYCIN/BACI/POLY B)EYE OINT",2600034,CDM,637,RC,,,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"NF-RONDEC DROPS (CARBINOXAMINE/PSE) DROP",2600870,CDM,637,RC,,,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"NF-SUDAL 60/500 (PSE/GUAIFENESIN) TAB",2606001,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NIFEREX FORTE-150 (IRON/B12/FOLIC) CAP",2602740,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"NIFEREX-150 (IRON COMPLEX) CAP",2602245,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NITROLINGUAL (NITRO) SPRAY 1 USE",2600093,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"NON-FORM TOPICAL TOP",2600095,CDM,637,RC,,,OUTPATIENT,,,185,148,,157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",46.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",104.53,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",64.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",127.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",107.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",37.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",157.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",37.68,166.5,
"NON-FORMULARY SUPP",2600098,CDM,637,RC,,,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"NYSTATIN OINT",2602275,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"OFLOXACIN 3% OTIC SOLN 10ML",2610157,CDM,637,RC,,,OUTPATIENT,,,64.55,51.64,,54.87,85,,,,,0,"percent of total billed charges","85% of total billed charges",16.14,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.14,25,,,,,0,"percent of total billed charges","25% of total billed charges",16.14,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",36.47,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.47,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.47,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",36.47,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",22.59,35,,,,,0,"percent of total billed charges","35% of total billed charges",44.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",58.1,90,,,,,0,"percent of total billed charges","90% of total billed charges",37.44,58,,,,,0,"percent of total billed charges","58% of total billed charges",13.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",54.87,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.15,58.1,
"PRENATAL (PRENATAL VITAMIN) TAB",2602842,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"ROXANOL (MORPHINE SULF) CONC LIQ 60MG",2603071,CDM,637,RC,,,OUTPATIENT,,,35,28,,29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",8.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",19.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",12.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",24.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",20.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",7.13,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",29.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",7.13,31.5,
"SILVER NIT. STICK TOP",2605011,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TRIAMCINOLONE 0.1% OINTMENT",2600432,CDM,637,RC,,,OUTPATIENT,,,30,24,,25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",7.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",16.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",10.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",20.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",27,90,,,,,0,"percent of total billed charges","90% of total billed charges",17.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",6.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",25.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",6.11,27,
"TRIPLE DYE APPLICATOR TOP",2600039,CDM,637,RC,,,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",4.07,18,
"TUCKS (HAMAMELIS LEAF/GLYCE) PAD",2600267,CDM,637,RC,,,OUTPATIENT,,,25,20,,21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",6.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",14.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",17.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",22.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",14.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",5.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",21.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",5.09,22.5,
"VOLTAREN (DICLOFENAC) OPHTH DROP",2602225,CDM,637,RC,,,OUTPATIENT,,,235,188,,199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",58.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",47.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",132.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",82.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",161.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",211.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",136.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",47.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",199.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",47.87,211.5,
"ZOVIRAX (ACYCLOVIR) LIQ 200MG/5ML",2601051,CDM,637,RC,,,OUTPATIENT,,,15,12,,12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",3.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",8.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",10.31,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",13.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",8.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",3.06,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",12.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",3.06,13.5,
"RECOVERY ROOM PER 15 MIN",1602200,CDM,710,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"FETAL MONITOR",408020,CDM,720,RC,59050,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"FETAL MONITOR",4059050,CDM,720,RC,59050,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",77.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",63.15,279,
"IM OR SUBQ INJECION (EACH)",490772,CDM,720,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IM OR SUBQ INJECTION (EACH)",4090772,CDM,720,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"INSERTION UMBILICAL ARTERY",405111,CDM,720,RC,36660,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",21.39,105,
"NON STRESS TEST",405065,CDM,720,RC,59025,HCPCS,OUTPATIENT,,,150,120,,127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",237.65,130,,,,,0,"fee schedule","130% of CMS OPPS rate",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",84.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",186.46,102,,,,,0,"fee schedule","102% of CMS OPPS rate",135,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",103.05,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",164.52,90,,,,,0,"fee schedule","90% of CMS OPPS rate",87,58,,,,,0,"percent of total billed charges","58% of total billed charges",30.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.56,237.65,
"O/P PROCEDURE/DAY ROOM",4000006,CDM,720,RC,99202,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",113,56.5,,35.04,35.04,35.04,"1 through 10","percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"OBSERVATION 1ST HR",4000001,CDM,720,RC,99222,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"STRESS TEST",405084,CDM,720,RC,59020,HCPCS,OUTPATIENT,,,170,136,,144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",237.65,130,,,,,0,"fee schedule","130% of CMS OPPS rate",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",96.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",186.46,102,,,,,0,"fee schedule","102% of CMS OPPS rate",153,90,,,,,0,"percent of total billed charges","90% of total billed charges",59.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",116.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",164.52,90,,,,,0,"fee schedule","90% of CMS OPPS rate",98.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",34.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",144.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",182.81,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.63,237.65,
"VAGINAL DELIVERY",4002310,CDM,720,RC,,,OUTPATIENT,,,2855,2284,,2426.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",713.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",713.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",713.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",581.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1613.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1613.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1613.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1613.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2569.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",999.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1961.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2569.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1655.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",581.56,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2426.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",581.56,2569.5,
"INSERTION UMBILICAL ARTERY",4036660,CDM,721,RC,36660,HCPCS,OUTPATIENT,,,105,84,,89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",59.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",94.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",36.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",72.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",60.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",21.39,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",89.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",105,100,,,,,0,"fee schedule","Pays at line item charges due to Status Indicator C on the CMS APC fee schedule",21.39,105,
"CIRCUMCISION SURG EXC NB",454150,CDM,723,RC,54150,HCPCS,OUTPATIENT,,,680,544,,578,85,,,,,0,"percent of total billed charges","85% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",170,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",384.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",238,35,,,,,0,"percent of total billed charges","35% of total billed charges",467.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",612,90,,,,,0,"percent of total billed charges","90% of total billed charges",394.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",138.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",138.52,612,
"CIRCUMCISION SURG EXC NB",4054150,CDM,723,RC,54160,HCPCS,OUTPATIENT,,,815,652,,692.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",203.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",460.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",285.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",559.91,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",733.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",472.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",166.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",166.02,733.5,
"LABOR CHECK",4000010,CDM,729,RC,,,OUTPATIENT,,,710,568,,603.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",177.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",401.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",248.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",487.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",639,90,,,,,0,"percent of total billed charges","90% of total billed charges",411.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",144.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",144.63,639,
EKG,5693005,CDM,730,RC,93005,HCPCS,OUTPATIENT,,,330,264,,280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",67.22,20.37,,46.13,35.29,54.34,"1 through 10","percent of total billed charges","20.37% of total billed charges",186.45,56.5,,153.86,52.68,182.79,17,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",186.45,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",297,90,,,,,0,"percent of total billed charges","90% of total billed charges",115.5,35,,51.03,51.03,51.03,"1 through 10","percent of total billed charges","35% of total billed charges",226.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",191.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",67.22,20.37,,49.68,7.36,52.68,25,"percent of total billed charges","20.37% of total billed charges",53.97,100,,42.32,42.32,42.32,257,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",280.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,297,
"RHYTHM STRIP CHG W EKG",5693041,CDM,730,RC,93041,HCPCS,OUTPATIENT,,,270,216,,229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",152.55,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",243,90,,,,,0,"percent of total billed charges","90% of total billed charges",94.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",185.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",156.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",229.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,243,
"EVENT MONITOR",5693270,CDM,731,RC,93270,HCPCS,OUTPATIENT,,,700,560,,595,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",44.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",395.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",34.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",630,90,,,,,0,"percent of total billed charges","90% of total billed charges",245,35,,,,,0,"percent of total billed charges","35% of total billed charges",480.9,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.49,90,,,,,0,"fee schedule","90% of CMS OPPS rate",406,58,,,,,0,"percent of total billed charges","58% of total billed charges",142.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",595,85,,,,,0,"percent of total billed charges","85% of total billed charges",33.88,100,,,,,0,"fee schedule","100% of CMS OPPS rate",30.49,630,
"HOLTER HOOK-UP W/SCAN",5693225,CDM,731,RC,93225,HCPCS,OUTPATIENT,,,760,608,,646,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",429.4,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",684,90,,,,,0,"percent of total billed charges","90% of total billed charges",266,35,,,,,0,"percent of total billed charges","35% of total billed charges",522.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",440.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",154.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,91.84,91.84,91.84,"1 through 10","fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",646,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,684,
"ANOSCOPY;W OR W/O SPECIME",1703111,CDM,750,RC,46600,HCPCS,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,12.41,12.41,12.41,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,3015,
"BIOPSY OF LIVER,NEEDLE; PERCUTANEOUS",1704700,CDM,750,RC,,,OUTPATIENT,,,5690,4552,,4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",1991.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3909.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",3300.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1159.05,5121,
COLONOSCOPY,1703001,CDM,750,RC,,,OUTPATIENT,,,4480,3584,,3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",1568,35,,,,,0,"percent of total billed charges","35% of total billed charges",3077.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",2598.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,4032,
"COLONOSCOPY CONTROL BLEED",1703028,CDM,750,RC,,,OUTPATIENT,,,5690,4552,,4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",1991.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3909.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",3300.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1159.05,5121,
"COLONOSCOPY SCREENING",1703018,CDM,750,RC,,,OUTPATIENT,,,3215,2572,,2732.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",803.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",803.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",803.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",654.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1816.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1816.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1816.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1816.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2893.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1125.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2208.71,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2893.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1864.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",654.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2732.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",654.9,2893.5,
"COLONOSCOPY SUBMUCOUS NJX",1745381,CDM,750,RC,45381,HCPCS,OUTPATIENT,,,4480,3584,,3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,297.59,111.44,483.74,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",1568,35,,,,,0,"percent of total billed charges","35% of total billed charges",3077.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2598.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,446.27,446.27,446.27,"1 through 10","fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4032,
"COLONOSCOPY THRU STOMA SPX",1744388,CDM,750,RC,44388,HCPCS,OUTPATIENT,,,4735,3788,,4024.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",964.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4261.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1657.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3252.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2746.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",964.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4024.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,4261.5,
"COLONOSCOPY TUMOR/POLY RM",1703026,CDM,750,RC,,,OUTPATIENT,,,5690,4552,,4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1422.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",1991.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3909.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5121,90,,,,,0,"percent of total billed charges","90% of total billed charges",3300.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1159.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4836.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1159.05,5121,
"COLONOSCOPY W BAND LIGATION",1745398,CDM,750,RC,,,OUTPATIENT,,,4840,3872,,4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",1694,35,,,,,0,"percent of total billed charges","35% of total billed charges",3325.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",2807.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.91,4356,
"COLONOSCOPY W STENT PLACEMENT",1745389,CDM,750,RC,45389,HCPCS,OUTPATIENT,,,16225,12980,,13791.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3305.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",14602.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5678.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",11146.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14602.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9410.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3305.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13791.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,14602.5,
"COLONOSCOPY W/BIOPSY",1703002,CDM,750,RC,,,OUTPATIENT,,,5735,4588,,4874.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1433.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1433.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1433.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1168.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5161.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2007.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3939.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5161.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3326.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1168.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4874.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1168.22,5161.5,
"COLONOSCOPY W/POLYP REMOV",1703009,CDM,750,RC,,,OUTPATIENT,,,5735,4588,,4874.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1433.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1433.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1433.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1168.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5161.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2007.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3939.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5161.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3326.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1168.22,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4874.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1168.22,5161.5,
"COLONOSCOPY WITH ABLATION",1703027,CDM,750,RC,,,OUTPATIENT,,,4355,3484,,3701.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1088.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1088.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1088.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",887.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3919.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1524.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2991.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3919.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2525.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",887.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3701.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",887.11,3919.5,
"DESTROY INTERNAL HEMORRHOIDS",1746930,CDM,750,RC,46930,HCPCS,OUTPATIENT,,,5410,4328,,4598.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1102.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4869,90,,,,,0,"percent of total billed charges","90% of total billed charges",1893.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3716.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",3137.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",1102.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4598.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,4869,
"DIAGNOSTIC SIGMODOSCOPY",1745330,CDM,750,RC,,,OUTPATIENT,,,4735,3788,,4024.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1183.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",964.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4261.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1657.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3252.95,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4261.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2746.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",964.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4024.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",964.52,4261.5,
"EGD DILATE STRICTURE",1743245,CDM,750,RC,43245,HCPCS,OUTPATIENT,,,6430,5144,,5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",2250.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4417.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",3729.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5787,
"EGD ENDOSCOPIC STENT PLACEMENT",1743266,CDM,750,RC,43266,HCPCS,OUTPATIENT,,,17375,13900,,14768.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",4343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",4343.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3539.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",15637.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6081.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",11936.63,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",15637.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",10077.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3539.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",14768.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,15637.5,
"EGD ESOPHOGASTRODUODNOSCO",1703000,CDM,750,RC,,,OUTPATIENT,,,3010,2408,,2558.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",613.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2709,90,,,,,0,"percent of total billed charges","90% of total billed charges",1053.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2067.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2709,90,,,,,0,"percent of total billed charges","90% of total billed charges",1745.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",613.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2558.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",613.14,2709,
"EGD GUIDE WIRE INSERTION",1743248,CDM,750,RC,43248,HCPCS,OUTPATIENT,,,4840,3872,,4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",1694,35,,,,,0,"percent of total billed charges","35% of total billed charges",3325.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2807.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,4356,
"EGD INJECTION VARICES",1743243,CDM,750,RC,43243,HCPCS,OUTPATIENT,,,6430,5144,,5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",2250.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4417.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",3729.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5787,
"EGD W/ RMVL OF PLYP TUMOR",1703020,CDM,750,RC,,,OUTPATIENT,,,3010,2408,,2558.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",613.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2709,90,,,,,0,"percent of total billed charges","90% of total billed charges",1053.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2067.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2709,90,,,,,0,"percent of total billed charges","90% of total billed charges",1745.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",613.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2558.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",613.14,2709,
"EGD W/ABLATION TUMOR/POLYP",1743250,CDM,750,RC,,,OUTPATIENT,,,3685,2948,,3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1289.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2531.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2137.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",750.63,3316.5,
"EGD W/BAND LIGATION  AND/OR GASTRIC VARI",1743244,CDM,750,RC,43244,HCPCS,OUTPATIENT,,,6430,5144,,5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",2250.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4417.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",3729.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5787,
"EGD W/DILITATION GDE WIRE",1703024,CDM,750,RC,43248,HCPCS,OUTPATIENT,,,3685,2948,,3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1289.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2531.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2137.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",750.63,3316.5,
"EGD WITH BALLOON DIALITAT",1703015,CDM,750,RC,,,OUTPATIENT,,,4840,3872,,4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",1694,35,,,,,0,"percent of total billed charges","35% of total billed charges",3325.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",2807.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.91,4356,
"EGD WITH BIOPSY",1703005,CDM,750,RC,,,OUTPATIENT,,,4840,3872,,4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",1210,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",1694,35,,,,,0,"percent of total billed charges","35% of total billed charges",3325.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",2807.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",985.91,4356,
"EGD WITH CONTROL BLEEDING",1703017,CDM,750,RC,,,OUTPATIENT,,,5025,4020,,4271.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1256.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1023.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4522.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1758.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3452.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4522.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2914.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1023.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4271.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1023.59,4522.5,
"EGD WITH DILITATION",1703019,CDM,750,RC,,,OUTPATIENT,,,4030,3224,,3425.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1007.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1007.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1007.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",820.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3627,90,,,,,0,"percent of total billed charges","90% of total billed charges",1410.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2768.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3627,90,,,,,0,"percent of total billed charges","90% of total billed charges",2337.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",820.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3425.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",820.91,3627,
"EGD WITH LESION ABLATION",1743270,CDM,750,RC,43270,HCPCS,OUTPATIENT,,,6430,5144,,5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",2250.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4417.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",3729.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5787,
"EGD WITH PEG PLACEMENT",1703013,CDM,750,RC,43246,HCPCS,OUTPATIENT,,,3685,2948,,3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1289.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2531.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2137.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",750.63,20.37,,37.49,37.49,37.49,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,1351.52,1351.52,1351.52,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",750.63,3316.5,
"EGD WITH REMOVAL FOREIGN",1703016,CDM,750,RC,43247,HCPCS,OUTPATIENT,,,4495,3596,,3820.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",915.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4045.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1573.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3088.07,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2607.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",915.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3820.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,4045.5,
"ENDOSCOPIC PANCREATOSCOPY",1743273,CDM,750,RC,43273,HCPCS,OUTPATIENT,,,10145,8116,,8623.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2066.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3550.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6969.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5884.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2066.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8623.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9130.5,
"ENTEROSCOPY W BLEED CONTROL",1744366,CDM,750,RC,44366,HCPCS,OUTPATIENT,,,7105,5684,,6039.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1776.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1776.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1776.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1447.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6394.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2486.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4881.14,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6394.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4120.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",1447.29,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6039.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6394.5,
"ERCP DUCT STENT PLACEMENT",1743274,CDM,750,RC,43274,HCPCS,OUTPATIENT,,,16225,12980,,13791.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3305.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",14602.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5678.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",11146.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14602.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9410.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3305.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13791.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,14602.5,
"ERCP EA DUCT/AMPULLA DILATE",1743277,CDM,750,RC,43277,HCPCS,OUTPATIENT,,,10485,8388,,8912.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2135.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3669.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7203.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6081.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2135.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8912.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9436.5,
"ERCP REMOVE DUCT CALCULI",1743264,CDM,750,RC,43264,HCPCS,OUTPATIENT,,,10485,8388,,8912.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2135.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3669.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7203.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6081.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2135.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8912.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9436.5,
"ERCP STENT EXCHANGE W/DILATE",1743276,CDM,750,RC,43276,HCPCS,OUTPATIENT,,,16225,12980,,13791.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",4056.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",3305.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",14602.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5678.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",11146.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",14602.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",9410.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",3305.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",13791.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,14602.5,
"ERCP W BX SINGLE/MULTIBLE",1743261,CDM,750,RC,43261,HCPCS,OUTPATIENT,,,10145,8116,,8623.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2536.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2066.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3550.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",6969.62,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9130.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",5884.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",2066.54,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8623.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9130.5,
"ERCP W SPHINCTER PAPILLOTOMY",1743262,CDM,750,RC,43262,HCPCS,OUTPATIENT,,,10485,8388,,8912.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2621.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2135.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3669.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7203.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6081.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",2135.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",8912.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9436.5,
"ERCP W/SPECIMEN COLLECTION",1743260,CDM,750,RC,43260,HCPCS,OUTPATIENT,,,11165,8932,,9490.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",2791.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2791.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",2791.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2274.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",10048.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3907.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",7670.36,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",10048.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6475.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",2274.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9490.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,10048.5,
"ESOPHAGAL DILITATION",1705035,CDM,750,RC,43248,HCPCS,OUTPATIENT,,,4030,3224,,3425.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",820.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3627,90,,,,,0,"percent of total billed charges","90% of total billed charges",1410.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2768.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2337.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",820.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3425.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,3627,
"ESOPHAGOSCOPY FLEX BIOSPSY",1743202,CDM,750,RC,43202,HCPCS,OUTPATIENT,,,4835,3868,,4109.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1208.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",984.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",4351.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1692.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3321.65,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4351.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2804.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",984.89,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4109.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,4351.5,
"ESOPHAGOSCOPY FLEX REMOVE FB",1743215,CDM,750,RC,43215,HCPCS,OUTPATIENT,,,7590,6072,,6451.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1897.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1897.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1897.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1546.08,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6831,90,,,,,0,"percent of total billed charges","90% of total billed charges",2656.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5214.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6831,90,,,,,0,"percent of total billed charges","90% of total billed charges",4402.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",1546.08,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6451.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6831,
"ESOPHAGOSCOPY LESION ABLATE",1743229,CDM,750,RC,43229,HCPCS,OUTPATIENT,,,10655,8524,,9056.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",2663.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2663.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",2663.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",2170.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",9589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3729.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",7319.99,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",9589.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",6179.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",2170.42,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",9056.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,9589.5,
"ESOPHAGOSCOPY WITH BALLOON <30MM",1743220,CDM,750,RC,43220,HCPCS,OUTPATIENT,,,6430,5144,,5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1607.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",2250.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4417.41,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5787,90,,,,,0,"percent of total billed charges","90% of total billed charges",3729.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1309.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5465.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,5787,
"ESOPHAGUS MOTILITY STUDY (MONOMETRY)",1791010,CDM,750,RC,91010,HCPCS,OUTPATIENT,,,2030,1624,,1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",626.83,130,,,,,0,"fee schedule","130% of CMS OPPS rate",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",491.82,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",710.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1394.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",433.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1177.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",413.51,1827,
"G ESOPH REFLUX MUCOSAL PH",1791035,CDM,750,RC,91035,HCPCS,OUTPATIENT,,,2030,1624,,1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",626.83,130,,,,,0,"fee schedule","130% of CMS OPPS rate",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",491.82,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1827,90,,,,,0,"percent of total billed charges","90% of total billed charges",710.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",1394.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",433.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1177.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",413.51,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1725.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",482.17,100,,,,,0,"fee schedule","100% of CMS OPPS rate",413.51,1827,
"HEMORRHOID BANDING",1746945,CDM,750,RC,,,OUTPATIENT,,,3350,2680,,2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",837.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",837.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",837.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1892.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1172.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2301.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3015,90,,,,,0,"percent of total billed charges","90% of total billed charges",1943,58,,,,,0,"percent of total billed charges","58% of total billed charges",682.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2847.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",682.4,3015,
"REMOVAL OF HEMORRHOID CLOT",1746320,CDM,750,RC,46320,HCPCS,OUTPATIENT,,,7670,6136,,6519.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",1562.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",6903,90,,,,,0,"percent of total billed charges","90% of total billed charges",2684.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",5269.29,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",4448.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1562.38,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6519.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",862.48,6903,
"SIGMOIDOSCOPE W/SUBMUC INJ",1745335,CDM,750,RC,45335,HCPCS,OUTPATIENT,,,4840,3872,,4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",4356,90,,,,,0,"percent of total billed charges","90% of total billed charges",1694,35,,,,,0,"percent of total billed charges","35% of total billed charges",3325.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2807.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",985.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4114,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,4356,
"SIGMOIDOSCOPY AND BIOPSY",1745331,CDM,750,RC,45331,HCPCS,OUTPATIENT,,,3685,2948,,3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1077.05,130,,,,,0,"fee schedule","130% of CMS OPPS rate",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,1206.42,1206.42,1206.42,"1 through 10","percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",845.07,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1289.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2531.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2137.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",828.5,100,,,,,0,"fee schedule","100% of CMS OPPS rate",745.64,3316.5,
"SIGMOIDOSCOPY DECOMPRESSION VOLVULUS",1703042,CDM,750,RC,,,OUTPATIENT,,,4480,3584,,3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",1568,35,,,,,0,"percent of total billed charges","35% of total billed charges",3077.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",2598.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,4032,
"SIGMOIDOSCOPY FLEX W BIOP",1703004,CDM,750,RC,,,OUTPATIENT,,,3685,2948,,3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",921.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1289.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2531.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2137.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",750.63,3316.5,
"SIGMOIDOSCOPY FLEX W POLY",1703021,CDM,750,RC,45338,HCPCS,OUTPATIENT,,,3685,2948,,3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1392.91,130,,,,,0,"fee schedule","130% of CMS OPPS rate",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",1092.9,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3316.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1289.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",2531.6,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",964.32,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2137.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",750.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3132.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1071.47,100,,,,,0,"fee schedule","100% of CMS OPPS rate",750.63,3316.5,
"SIGMOIDOSCOPY FLEXIBLE",1703003,CDM,750,RC,,,OUTPATIENT,,,3010,2408,,2558.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",752.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",613.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1700.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2709,90,,,,,0,"percent of total billed charges","90% of total billed charges",1053.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",2067.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2709,90,,,,,0,"percent of total billed charges","90% of total billed charges",1745.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",613.14,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2558.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",613.14,2709,
"SIGMOIDOSCOPY TUMOR/POLYP",1703030,CDM,750,RC,,,OUTPATIENT,,,4355,3484,,3701.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1088.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1088.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1088.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",887.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",3919.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1524.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2991.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",3919.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2525.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",887.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3701.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",887.11,3919.5,
"SIGMOIDOSCOPY W/ ABLATION OF TUMOR/POLYP",1703040,CDM,750,RC,,,OUTPATIENT,,,4480,3584,,3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",1568,35,,,,,0,"percent of total billed charges","35% of total billed charges",3077.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",2598.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,4032,
"SIGMOIDOSCOPY W/ CONTROL OF BLEEDING",1703041,CDM,750,RC,,,OUTPATIENT,,,4480,3584,,3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",1120,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",1568,35,,,,,0,"percent of total billed charges","35% of total billed charges",3077.76,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4032,90,,,,,0,"percent of total billed charges","90% of total billed charges",2598.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",912.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",3808,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",912.58,4032,
"SMALL BOWEL ENDOSCOPY",1744360,CDM,750,RC,44360,HCPCS,OUTPATIENT,,,6765,5412,,5750.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1691.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1691.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1691.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1378.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",6088.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2367.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",4647.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6088.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3923.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1378.03,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5750.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,6088.5,
"SMALL INTESTINAL ENDO",1744376,CDM,750,RC,44376,HCPCS,OUTPATIENT,,,4870,3896,,4139.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1217.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1217.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1217.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",992.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",,,,,,,0,other,"not separately reimbursable",4383,90,,,,,0,"percent of total billed charges","90% of total billed charges",1704.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3345.69,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4383,90,,,,,0,"percent of total billed charges","90% of total billed charges",2824.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",992.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4139.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",862.48,4383,
"UPPER GI SCOPE W SUBMUC INJ",1743236,CDM,750,RC,43236,HCPCS,OUTPATIENT,,,4060,3248,,3451,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",827.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",862.48,100,,,,,0,"percent of total billed charges","100% of total billed charges",986.63,100,,,,,0,"percent of total billed charges","100% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3654,90,,,,,0,"percent of total billed charges","90% of total billed charges",1421,35,,,,,0,"percent of total billed charges","35% of total billed charges",2789.22,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2354.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",827.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3451,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,3654,
"IM INJECTION VACCINE",1090471,CDM,760,RC,90471,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IM OR SUBQ INJECTION (EACH)",1090772,CDM,760,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IMMUNIZATION ADMIN EACH ADD",2090472,CDM,760,RC,90472,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",62.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",50.93,225,
"IV  ADDITIONAL SEQUENTIAL INFUSION",1090767,CDM,760,RC,96367,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",56.02,20.37,,43.39,43.39,43.39,"1 through 10","percent of total billed charges","20.37% of total billed charges",155.38,56.5,,64.02,64.02,64.02,"1 through 10","percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.95,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,39.91,36.72,43.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",64.67,100,,50.71,50.71,50.71,"1 through 10","fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",56.02,247.5,
"IV 2ND SITE/THERAPEUTIC/PIGGYBACK",1096365,CDM,760,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"IV HYDRATION ADDITIONAL HRS",1090761,CDM,760,RC,96361,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,866.92,238.80,896.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,28.74,28.74,28.74,"1 through 10","percent of total billed charges","35% of total billed charges",123.66,68.7,,70.20,70.20,70.20,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,316.12,316.12,316.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,82,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",36.67,162,
"IV HYDRATION ADDITIONAL HRS",1590761,CDM,760,RC,96361,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,866.92,238.80,896.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,28.74,28.74,28.74,"1 through 10","percent of total billed charges","35% of total billed charges",123.66,68.7,,70.20,70.20,70.20,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,316.12,316.12,316.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,82,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",36.67,162,
"IV HYDRATION ADDITIONAL HRS",4090761,CDM,760,RC,96361,HCPCS,OUTPATIENT,,,180,144,,153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",36.67,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",101.7,56.5,,866.92,238.80,896.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",101.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",162,90,,,,,0,"percent of total billed charges","90% of total billed charges",63,35,,28.74,28.74,28.74,"1 through 10","percent of total billed charges","35% of total billed charges",123.66,68.7,,70.20,70.20,70.20,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",104.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",36.67,20.37,,316.12,316.12,316.12,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,82,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",153,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",36.67,162,
"IV HYDRATION INITIAL",1090760,CDM,760,RC,96360,HCPCS,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",129.35,20.37,,103.44,103.44,103.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",358.78,56.5,,165.00,145.40,184.60,"1 through 10","percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,101.37,101.37,101.37,"1 through 10","percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,57.47,28.74,100.18,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,43,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.35,571.5,
"IV HYDRATION INITIAL",1590760,CDM,760,RC,96360,HCPCS,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",129.35,20.37,,103.44,103.44,103.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",358.78,56.5,,165.00,145.40,184.60,"1 through 10","percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,101.37,101.37,101.37,"1 through 10","percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,57.47,28.74,100.18,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,43,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.35,571.5,
"IV HYDRATION INITIAL",4090760,CDM,760,RC,96360,HCPCS,OUTPATIENT,,,635,508,,539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",129.35,20.37,,103.44,103.44,103.44,"1 through 10","percent of total billed charges","20.37% of total billed charges",358.78,56.5,,165.00,145.40,184.60,"1 through 10","percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",358.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",571.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",222.25,35,,101.37,101.37,101.37,"1 through 10","percent of total billed charges","35% of total billed charges",436.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",368.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",129.35,20.37,,57.47,28.74,100.18,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,43,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",539.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",129.35,571.5,
"IV INFUSION (INITIAL)(UP TO 1 HOUR)",490765,CDM,760,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"IV INITIAL/THERAPEUTIC/PIGGYBACK",1090765,CDM,760,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"IV INITIAL/THERAPEUTIC/PIGGYBACK",1596365,CDM,760,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"IV INITIAL/THERAPEUTIC/PIGGYBACK",4090765,CDM,760,RC,96365,HCPCS,OUTPATIENT,,,430,344,,365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",87.59,20.37,,67.83,67.83,67.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",242.95,56.5,,182.87,47.44,462.89,"1 through 10","percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",242.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",387,90,,,,,0,"percent of total billed charges","90% of total billed charges",150.5,35,,68.65,68.65,68.65,"1 through 10","percent of total billed charges","35% of total billed charges",295.41,68.7,,30.63,30.63,30.63,"1 through 10","percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",249.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",87.59,20.37,,68.65,68.65,71.29,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,93,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",365.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",87.59,387,
"IV PUSH",1590774,CDM,760,RC,96374,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",60.09,20.37,,49.46,49.46,49.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",166.68,56.5,,140.50,49.77,419.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,108.28,59.34,157.22,"1 through 10","percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,47.10,47.10,47.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,101,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",60.09,265.5,
"IV PUSH  (PER MED)",4090774,CDM,760,RC,96374,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",60.09,20.37,,49.46,49.46,49.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",166.68,56.5,,140.50,49.77,419.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,108.28,59.34,157.22,"1 through 10","percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,47.10,47.10,47.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,101,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",60.09,265.5,
"IV PUSH EACH ADDITIONAL DRUG",4090776,CDM,760,RC,96376,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,70.99,70.99,70.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"IV PUSH EACH ADDITIONAL NEW DRUG",1090775,CDM,760,RC,96375,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",49.91,20.37,,61.03,44.13,77.92,"1 through 10","percent of total billed charges","20.37% of total billed charges",138.43,56.5,,543.80,39.03,931.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","35% of total billed charges",168.32,68.7,,13.42,13.42,13.42,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,80,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,220.5,
"IV PUSH EACH ADDITIONAL NEW DRUG",1590775,CDM,760,RC,96375,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",49.91,20.37,,61.03,44.13,77.92,"1 through 10","percent of total billed charges","20.37% of total billed charges",138.43,56.5,,543.80,39.03,931.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","35% of total billed charges",168.32,68.7,,13.42,13.42,13.42,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,80,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,220.5,
"IV PUSH EACH ADDITIONAL NEW DRUG",4090775,CDM,760,RC,96375,HCPCS,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",49.91,20.37,,61.03,44.13,77.92,"1 through 10","percent of total billed charges","20.37% of total billed charges",138.43,56.5,,543.80,39.03,931.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","35% of total billed charges",168.32,68.7,,13.42,13.42,13.42,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,39.11,39.11,39.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,32.87,32.87,98.62,80,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,220.5,
"IV PUSH EACH ADDITIONAL SAME DRUG",1090776,CDM,760,RC,96376,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,70.99,70.99,70.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"IV PUSH EACH ADDITIONAL SAME DRUG",1590776,CDM,760,RC,96376,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,70.99,70.99,70.99,"1 through 10","percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"IV PUSH INITIAL",1090774,CDM,760,RC,96374,HCPCS,OUTPATIENT,,,295,236,,250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",248.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",60.09,20.37,,49.46,49.46,49.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",166.68,56.5,,140.50,49.77,419.92,"1 through 10","percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",166.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",195.28,102,,,,,0,"fee schedule","102% of CMS OPPS rate",265.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",103.25,35,,108.28,59.34,157.22,"1 through 10","percent of total billed charges","35% of total billed charges",202.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",172.31,90,,,,,0,"fee schedule","90% of CMS OPPS rate",171.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",60.09,20.37,,47.10,47.10,47.10,"1 through 10","percent of total billed charges","20.37% of total billed charges",191.46,100,,150.11,150.11,150.11,101,"fee schedule","100% of CMS OPPS rate",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",250.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",191.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",60.09,265.5,
"IV THERAPEUTIC ADDITIONAL HR",1090766,CDM,760,RC,96366,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",41.76,20.37,,33.40,33.40,33.40,"1 through 10","percent of total billed charges","20.37% of total billed charges",115.83,56.5,,103.76,53.95,153.56,"1 through 10","percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,95.09,95.09,95.09,"1 through 10","percent of total billed charges","35% of total billed charges",140.84,68.7,,26.83,26.83,26.83,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,32.72,32.72,32.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,65.75,32.87,78.90,17,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,184.5,
"IV THERAPEUTIC ADDITIONAL HR",1596366,CDM,760,RC,96366,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",41.76,20.37,,33.40,33.40,33.40,"1 through 10","percent of total billed charges","20.37% of total billed charges",115.83,56.5,,103.76,53.95,153.56,"1 through 10","percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,95.09,95.09,95.09,"1 through 10","percent of total billed charges","35% of total billed charges",140.84,68.7,,26.83,26.83,26.83,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,32.72,32.72,32.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,65.75,32.87,78.90,17,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,184.5,
"IV THERAPEUTIC ADDITIONAL HRS",4090766,CDM,760,RC,96366,HCPCS,OUTPATIENT,,,205,164,,174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",41.76,20.37,,33.40,33.40,33.40,"1 through 10","percent of total billed charges","20.37% of total billed charges",115.83,56.5,,103.76,53.95,153.56,"1 through 10","percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",115.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",184.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",71.75,35,,95.09,95.09,95.09,"1 through 10","percent of total billed charges","35% of total billed charges",140.84,68.7,,26.83,26.83,26.83,"1 through 10","percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",118.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",41.76,20.37,,32.72,32.72,32.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",41.92,100,,65.75,32.87,78.90,17,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",174.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,184.5,
"CASIRIVI AND IMDEV INFUSION",2610243,CDM,761,RC,M0243,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",532.2,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",417.57,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",368.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",325.92,1440,
"SOTROVIMAB INFUSION",2610247,CDM,761,RC,M0247,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",532.2,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",417.57,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",368.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",409.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",325.92,1440,
"ACNE SURGERY",1510040,CDM,761,RC,10040,HCPCS,OUTPATIENT,,,505,404,,429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",234.73,130,,,,,0,"fee schedule","130% of CMS OPPS rate",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",285.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",184.17,102,,,,,0,"fee schedule","102% of CMS OPPS rate",454.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",176.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",346.94,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.5,90,,,,,0,"fee schedule","90% of CMS OPPS rate",292.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",102.87,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",429.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",180.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",102.87,454.5,
"BIOPSY BREAST ADDL AREA INC US GUIDANNCE",4619084,CDM,761,RC,19084,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",312.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",92.68,409.5,
"BIOPSY BREAST INCLUDING US GUIDANNCE",4619083,CDM,761,RC,19083,HCPCS,OUTPATIENT,,,5285,4228,,4492.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",1321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",1321.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1076.55,20.37,,430.46,430.46,430.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",2000,56.5,,894.74,406.40,1638.13,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4756.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1849.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",3630.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4756.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3065.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",1076.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,1154.34,1154.34,1154.34,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4492.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1076.55,4756.5,
"BIOPSY OF THYROID",4660100,CDM,761,RC,60100,HCPCS,OUTPATIENT,,,2575,2060,,2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2317.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",901.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1769.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1493.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",524.53,2317.5,
"CENTRAL LINE PLACEMENT",1036556,CDM,761,RC,36556,HCPCS,OUTPATIENT,,,3000,2400,,2550,85,,,,,0,"percent of total billed charges","85% of total billed charges",750,25,,,,,0,"percent of total billed charges","25% of total billed charges",750,25,,,,,0,"percent of total billed charges","25% of total billed charges",750,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",611.1,20.37,,78.83,78.83,78.83,"1 through 10","percent of total billed charges","20.37% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1695,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",2700,90,,,,,0,"percent of total billed charges","90% of total billed charges",1050,35,,,,,0,"percent of total billed charges","35% of total billed charges",2061,68.7,,5294.72,5294.72,5294.72,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",2700,90,,,,,0,"percent of total billed charges","90% of total billed charges",1740,58,,,,,0,"percent of total billed charges","58% of total billed charges",611.1,20.37,,324.09,324.09,324.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,2242.45,2242.45,2242.45,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",2550,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",611.1,2700,
"CHANGE OF URETER TUBE STINT",2050688,CDM,761,RC,50688,HCPCS,OUTPATIENT,,,5115,4092,,4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1278.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1790.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3514.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4603.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2966.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",1041.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4347.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1041.93,4603.5,
"DECLOT VASCULAR DEVICE",1036593,CDM,761,RC,36593,HCPCS,OUTPATIENT,,,1200,960,,1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",391.84,130,,,,,0,"fee schedule","130% of CMS OPPS rate",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",678,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",307.44,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1080,90,,,,,0,"percent of total billed charges","90% of total billed charges",420,35,,,,,0,"percent of total billed charges","35% of total billed charges",824.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",271.27,90,,,,,0,"fee schedule","90% of CMS OPPS rate",696,58,,,,,0,"percent of total billed charges","58% of total billed charges",244.44,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",301.42,100,,236.32,236.32,236.32,"1 through 10","fee schedule","100% of CMS OPPS rate",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1020,85,,,,,0,"percent of total billed charges","85% of total billed charges",301.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",244.44,1080,
"DRAINAGE OF SCROTUM",2054700,CDM,761,RC,54700,HCPCS,OUTPATIENT,,,6630,5304,,5635.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1657.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1657.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1657.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1350.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5967,90,,,,,0,"percent of total billed charges","90% of total billed charges",2320.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4554.81,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5967,90,,,,,0,"percent of total billed charges","90% of total billed charges",3845.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",1350.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5635.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1350.53,5967,
"EXCISION TUMOR SOFT TISSUE < 3CM",1721555,CDM,761,RC,21555,HCPCS,OUTPATIENT,,,5970,4776,,5074.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1492.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1492.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1492.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1216.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,1373.49,537.54,2209.43,"1 through 10","percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5373,90,,,,,0,"percent of total billed charges","90% of total billed charges",2089.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",4101.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5373,90,,,,,0,"percent of total billed charges","90% of total billed charges",3462.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",1216.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,78.93,78.93,78.93,"1 through 10",other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5074.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1216.09,5373,
"FINE NEEDLE ASPIR BX W/US GDN 1ST LESSIO",4610005,CDM,761,RC,10005,HCPCS,OUTPATIENT,,,2575,2060,,2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",524.53,20.37,,50.72,50.72,50.72,"1 through 10","percent of total billed charges","20.37% of total billed charges",1454.88,56.5,,722.87,69.70,1832.23,"1 through 10","percent of total billed charges","50.56% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1454.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2317.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",901.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1769.03,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1493.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",524.53,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,501.27,476.90,501.27,"1 through 10","fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2188.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",524.53,2317.5,
"FINE NEEDLE ASPIR BX W/US GDN EA ADDL LE",4610006,CDM,761,RC,10006,HCPCS,OUTPATIENT,,,455,364,,386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",113.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",257.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",312.59,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",409.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",263.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",92.68,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",386.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",92.68,409.5,
"I & D  ABSCESS COMPLIATED",1010061,CDM,761,RC,,,OUTPATIENT,,,1005,804,,854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",251.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",204.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",567.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",351.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",690.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",904.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",582.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",204.72,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",854.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",204.72,904.5,
"I&D HMTMA SEROMA/FLUID COLLJ",1010140,CDM,761,RC,10140,HCPCS,OUTPATIENT,,,6500,5200,,5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",1625,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",2275,35,,,,,0,"percent of total billed charges","35% of total billed charges",4465.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",5850,90,,,,,0,"percent of total billed charges","90% of total billed charges",3770,58,,,,,0,"percent of total billed charges","58% of total billed charges",1324.05,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",5525,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1324.05,5850,
"IM INJECT ANESTHETIC AGENT FACIAL NERVE",2064402,CDM,761,RC,64999,HCPCS,OUTPATIENT,,,310,248,,263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",175.15,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",279,90,,,,,0,"percent of total billed charges","90% of total billed charges",108.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",212.97,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",179.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",63.15,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",263.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",63.15,348.72,
"IM INJECTION OR SUBCUTANEOUS",200013,CDM,761,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IM INJECTION OR SUBCUTANEOUS",2000013,CDM,761,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"IMG GID FLUE COLL DRG SFT TIS",4010030,CDM,761,RC,10030,HCPCS,OUTPATIENT,,,2500,2000,,2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1412.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2250,90,,,,,0,"percent of total billed charges","90% of total billed charges",875,35,,,,,0,"percent of total billed charges","35% of total billed charges",1717.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1450,58,,,,,0,"percent of total billed charges","58% of total billed charges",509.25,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2125,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",509.25,2250,
"INS TEMP BLADDER CATH",1551702,CDM,761,RC,51702,HCPCS,OUTPATIENT,,,335,268,,284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",68.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",189.28,56.5,,604.54,451.61,1070.84,"1 through 10","percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",189.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",301.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",117.25,35,,129.88,129.88,129.88,"1 through 10","percent of total billed charges","35% of total billed charges",230.15,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",194.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",68.24,20.37,,134.11,134.11,134.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",284.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",68.24,301.5,
"INSERT PICVAD CATH",1536571,CDM,761,RC,36571,HCPCS,OUTPATIENT,,,7675,6140,,6523.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1918.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1918.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1918.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1563.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",6907.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",2686.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",5272.73,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",6907.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",4451.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1563.4,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",6523.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1563.4,6907.5,
"IRRIGATION OF IMPLANTED VENOUS ACCESS",1596523,CDM,761,RC,96523,HCPCS,OUTPATIENT,,,485,388,,412.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",70.17,130,,,,,0,"fee schedule","130% of CMS OPPS rate",98.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",274.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",274.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",274.03,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",274.03,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",55.05,102,,,,,0,"fee schedule","102% of CMS OPPS rate",436.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",169.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",333.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,90,,,,,0,"fee schedule","90% of CMS OPPS rate",281.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",98.79,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",412.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",53.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",48.58,436.5,
"O/P PROCEDURE/DAY ROOM",2000006,CDM,761,RC,99211,HCPCS,OUTPATIENT,,,200,160,,170,85,,,,,0,"percent of total billed charges","85% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",50,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",113,56.5,,181.68,181.68,181.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",113,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",70,35,,,,,0,"percent of total billed charges","35% of total billed charges",137.4,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",180,90,,,,,0,"percent of total billed charges","90% of total billed charges",116,58,,,,,0,"percent of total billed charges","58% of total billed charges",40.74,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",170,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",40.74,180,
"OUTPATIENT PROCEDURE",2099211,CDM,761,RC,99211,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,181.68,181.68,181.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"OUTPATIENT PROCEDURE",4099211,CDM,761,RC,99211,HCPCS,OUTPATIENT,,,230,184,,195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",57.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",129.95,56.5,,181.68,181.68,181.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",129.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",80.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",158.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",207,90,,,,,0,"percent of total billed charges","90% of total billed charges",133.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",46.85,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",195.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",46.85,207,
"OUTPATIENT PROCEDURE/TREATMENT",1000006,CDM,761,RC,99211,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,64.68,64.68,64.68,"1 through 10","percent of total billed charges","20.37% of total billed charges",231.65,56.5,,181.68,181.68,181.68,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,65.46,65.46,65.46,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"OUTPATIENT PROCEDURE/TREATMENT",1500006,CDM,761,RC,G0463,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.1,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.1,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.1,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.24,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,115.91,41.93,115.91,"1 through 10","percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.44,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.1,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.39,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.1,100,,91.81,91.81,91.81,34,"fee schedule","100% of CMS OPPS rate",117.1,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.1,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,369,
PERITONOCENTESIS,1049080,CDM,761,RC,49083,HCPCS,OUTPATIENT,,,3475,2780,,2953.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1107.58,130,,,,,0,"fee schedule","130% of CMS OPPS rate",707.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1963.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",869.03,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3127.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1216.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",2387.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",766.79,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2015.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",707.86,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",2953.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",851.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",707.86,3127.5,
"PERQ DEV SOFT TISS 1ST IMG",1510035,CDM,761,RC,10035,HCPCS,OUTPATIENT,,,2245,1796,,1908.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",457.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1268.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1268.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2020.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",785.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1542.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1302.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",457.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1908.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",457.31,2020.5,
"PLACEMENT OF BREAST LOCALIZATION DEVICE",4619285,CDM,761,RC,19285,HCPCS,OUTPATIENT,,,1935,1548,,1644.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.19,130,,,,,0,"fee schedule","130% of CMS OPPS rate",394.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1093.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1093.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1093.28,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1093.28,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1741.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",677.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1329.35,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1122.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",394.16,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1644.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",394.16,1741.5,
"PUNCH BX SKIN SINGLE LESION",1011104,CDM,761,RC,11104,HCPCS,OUTPATIENT,,,1400,1120,,1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",285.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",791,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",791,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",791,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",791,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1260,90,,,,,0,"percent of total billed charges","90% of total billed charges",490,35,,123.56,123.56,123.56,"1 through 10","percent of total billed charges","35% of total billed charges",961.8,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",812,58,,,,,0,"percent of total billed charges","58% of total billed charges",285.18,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1190,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.18,1260,
"PUNCH BX SKIN SINGLE LESION",4011104,CDM,761,RC,11104,HCPCS,OUTPATIENT,,,1500,1200,,1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.98,130,,,,,0,"fee schedule","130% of CMS OPPS rate",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",847.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",370.33,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1350,90,,,,,0,"percent of total billed charges","90% of total billed charges",525,35,,123.56,123.56,123.56,"1 through 10","percent of total billed charges","35% of total billed charges",1030.5,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.75,90,,,,,0,"fee schedule","90% of CMS OPPS rate",870,58,,,,,0,"percent of total billed charges","58% of total billed charges",305.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1275,85,,,,,0,"percent of total billed charges","85% of total billed charges",363.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",305.55,1350,
"SB BLOOD ADMINISTRATION",3136430,CDM,761,RC,36430,HCPCS,OUTPATIENT,,,1765,1412,,1500.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",516.46,130,,,,,0,"fee schedule","130% of CMS OPPS rate",359.53,20.37,,287.51,287.51,287.51,"1 through 10","percent of total billed charges","20.37% of total billed charges",997.23,56.5,,1092.93,522.14,1663.72,"1 through 10","percent of total billed charges","50.56% of total billed charges",997.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",997.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",997.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",405.22,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1588.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",617.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1212.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.55,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1023.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",359.53,20.37,,281.79,281.79,281.79,"1 through 10","percent of total billed charges","20.37% of total billed charges",397.28,100,,311.46,311.46,311.46,"1 through 10","fee schedule","100% of CMS OPPS rate",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1500.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",397.28,100,,,,,0,"fee schedule","100% of CMS OPPS rate",357.55,1588.5,
"SFT TISSUE BX NECK/THORAX",4621550,CDM,761,RC,21550,HCPCS,OUTPATIENT,,,5475,4380,,4653.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",1368.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1368.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",1368.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",1115.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4927.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",1916.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",3761.33,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4927.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",3175.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",1115.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4653.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",1115.26,4927.5,
"TRIGGER POINT INJECTION SINGLE/MULTIPLE",2020552,CDM,761,RC,20552,HCPCS,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.72,130,,,,,0,"fee schedule","130% of CMS OPPS rate",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",273.61,102,,,,,0,"fee schedule","102% of CMS OPPS rate",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",241.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",268.25,100,,,,,0,"fee schedule","100% of CMS OPPS rate",56.02,348.72,
"XR THYROID BPSY PERCU CORE",4060100,CDM,761,RC,60100,HCPCS,OUTPATIENT,,,2320,1856,,1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",831.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1310.8,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",652.16,102,,,,,0,"fee schedule","102% of CMS OPPS rate",2088,90,,,,,0,"percent of total billed charges","90% of total billed charges",812,35,,,,,0,"percent of total billed charges","35% of total billed charges",1593.84,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",575.44,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1345.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",472.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1972,85,,,,,0,"percent of total billed charges","85% of total billed charges",639.38,100,,,,,0,"fee schedule","100% of CMS OPPS rate",472.58,2088,
"FOLEY CATH INSERTION COMPLIC",1051703,CDM,762,RC,51703,HCPCS,OUTPATIENT,,,565,452,,480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",319.23,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",508.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",197.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",388.16,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",327.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",115.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,111.47,111.47,111.47,"1 through 10","fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",480.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",115.09,508.5,
"FOLEY CATH INSERTION SIMP",1051702,CDM,762,RC,51702,HCPCS,OUTPATIENT,,,880,704,,748,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",179.26,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",497.2,56.5,,604.54,451.61,1070.84,"1 through 10","percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",497.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",792,90,,,,,0,"percent of total billed charges","90% of total billed charges",308,35,,129.88,129.88,129.88,"1 through 10","percent of total billed charges","35% of total billed charges",604.56,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",510.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",179.26,20.37,,134.11,134.11,134.11,"1 through 10","percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",748,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,792,
"I & D  SUPERFICIAL ABSCESS",1046045,CDM,762,RC,,,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"IN & OUT CATHETERIZATION",4051701,CDM,762,RC,51701,HCPCS,OUTPATIENT,,,840,672,,714,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",474.6,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",756,90,,,,,0,"percent of total billed charges","90% of total billed charges",294,35,,,,,0,"percent of total billed charges","35% of total billed charges",577.08,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",487.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",171.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",714,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,756,
"INTRO OF NEEDLE OR ENTRACATHETER",1036000,CDM,762,RC,36000,HCPCS,OUTPATIENT,,,225,180,,191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",56.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",127.13,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",78.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",154.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",202.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",130.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",45.83,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",191.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",45.83,202.5,
"NASOGASTRIC TUBE PLACEMEN",1043752,CDM,762,RC,43752,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",471.41,130,,,,,0,"fee schedule","130% of CMS OPPS rate",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",369.87,102,,,,,0,"fee schedule","102% of CMS OPPS rate",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",326.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",362.62,100,,,,,0,"fee schedule","100% of CMS OPPS rate",83.52,471.41,
"OBSERVATION (DIRECT ADM)",100003,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,551.69,519.66,583.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",307.93,56.5,,401.02,191.80,635.28,"1 through 10","percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,2369.11,2369.11,2369.11,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,208.35,181.05,226.15,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"OBSERVATION (DIRECT ADM)",400003,CDM,762,RC,G0379,HCPCS,OUTPATIENT,,,20,16,,17,85,,,,,0,"percent of total billed charges","85% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",724.29,130,,,,,0,"fee schedule","130% of CMS OPPS rate",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",11.3,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",568.29,102,,,,,0,"fee schedule","102% of CMS OPPS rate",18,90,,,,,0,"percent of total billed charges","90% of total billed charges",7,35,,,,,0,"percent of total billed charges","35% of total billed charges",13.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",501.43,90,,,,,0,"fee schedule","90% of CMS OPPS rate",11.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",4.07,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",557.14,100,,1886.38,1886.38,1886.38,"1 through 10","fee schedule","100% of CMS OPPS rate",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17,85,,,,,0,"percent of total billed charges","85% of total billed charges",557.14,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4.07,724.29,
"OBSERVATION 1ST HOUR",100001,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,545,436,,463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",136.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,20.37,,551.69,519.66,583.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",307.93,56.5,,401.02,191.80,635.28,"1 through 10","percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",307.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",190.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",374.42,68.7,,2369.11,2369.11,2369.11,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",490.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",111.02,20.37,,208.35,181.05,226.15,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",463.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",111.02,490.5,
"OBSERVATION 1ST HOUR",400001,CDM,762,RC,99222,HCPCS,OUTPATIENT,,,410,328,,348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",102.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",231.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",143.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",281.67,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",369,90,,,,,0,"percent of total billed charges","90% of total billed charges",237.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",83.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",348.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",83.52,369,
"OBSERVATION 1ST HR",2099219,CDM,762,RC,99222,HCPCS,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,139.5,
"OBSERVATION ADDITIONAL HR",100002,CDM,762,RC,G0378,HCPCS,OUTPATIENT,,,90,72,,76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",22.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,20.37,,551.69,519.66,583.71,"1 through 10","percent of total billed charges","20.37% of total billed charges",50.85,56.5,,401.02,191.80,635.28,"1 through 10","percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",50.85,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",61.83,68.7,,2369.11,2369.11,2369.11,"1 through 10","percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",81,90,,,,,0,"percent of total billed charges","90% of total billed charges",52.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",18.33,20.37,,208.35,181.05,226.15,"1 through 10","percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",76.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",18.33,81,
"OBSERVATION ADDITIONAL HR",400002,CDM,762,RC,99222,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"OBSERVATION ADDITIONAL HR",4000002,CDM,762,RC,99222,HCPCS,OUTPATIENT,,,80,64,,68,85,,,,,0,"percent of total billed charges","85% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",20,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",45.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",28,35,,,,,0,"percent of total billed charges","35% of total billed charges",54.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",72,90,,,,,0,"percent of total billed charges","90% of total billed charges",46.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",16.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",68,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",16.3,72,
"OBSERVATION EA ADD H",2000012,CDM,762,RC,99222,HCPCS,OUTPATIENT,,,55,44,,46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",13.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",31.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",19.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",37.79,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",31.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",11.2,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",46.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",11.2,49.5,
"OUTPT IM INJ ANTIBIOTIC",2000007,CDM,769,RC,96372,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.07,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,83.82,83.82,83.82,"1 through 10","percent of total billed charges","20.37% of total billed charges",141.25,56.5,,790.21,579.98,910.58,12,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",65.96,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,38.65,38.65,38.65,"1 through 10","percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",58.2,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,66.23,39.92,79.83,12,"percent of total billed charges","20.37% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",64.67,100,,,,,0,"fee schedule","100% of CMS OPPS rate",50.93,225,
"BAMLANIVIMAB POST ADMIN MONITORING",2610239,CDM,771,RC,,,OUTPATIENT,,,1230,984,,1045.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",307.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",307.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",307.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",250.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",694.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",694.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",694.95,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",694.95,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",1107,90,,,,,0,"percent of total billed charges","90% of total billed charges",430.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",845.01,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",1107,90,,,,,0,"percent of total billed charges","90% of total billed charges",713.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",250.55,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.5,,,,,,0,"case rate","pays based on per visit rate",20.5,1107,
"ADMIN 3RD PFIZER DOSE COVID19 VACCINE",2611118,CDM,771,RC,,,OUTPATIENT,,,190,152,,161.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",47.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",38.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",107.35,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",171,90,,,,,0,"percent of total billed charges","90% of total billed charges",66.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",130.53,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",171,90,,,,,0,"percent of total billed charges","90% of total billed charges",110.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",38.7,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.5,,,,,,0,"case rate","pays based on per visit rate",20.5,171,
"IM INJECTION HEPATITIS B VACCINE",1000010,CDM,771,RC,G0010,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,225,
"IM INJECTION INFLUENZA VACCINE",1000008,CDM,771,RC,G0008,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",62.42,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,225,
"IM INJECTION PNEUMONCOCCAL VACCINE",1000009,CDM,771,RC,G0009,HCPCS,OUTPATIENT,,,250,200,,212.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",54.5,130,,,,,0,"fee schedule","130% of CMS OPPS rate",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",141.25,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",42.76,102,,,,,0,"fee schedule","102% of CMS OPPS rate",225,90,,,,,0,"percent of total billed charges","90% of total billed charges",87.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",171.75,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,90,,,,,0,"fee schedule","90% of CMS OPPS rate",145,58,,,,,0,"percent of total billed charges","58% of total billed charges",50.93,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",41.92,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.72,225,
"MODERNA LOW DOSE BOOSTER",2611119,CDM,771,RC,,,OUTPATIENT,,,155,124,,131.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",38.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",87.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",54.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",106.49,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",139.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",89.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",31.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",20.5,,,,,,0,"case rate","pays based on per visit rate",20.5,139.5,
"CYSTO W/ REMOVAL OF FOREIGN OBJECT",1552310,CDM,790,RC,52310,HCPCS,OUTPATIENT,,,4750,3800,,4037.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",1187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",1187.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",4275,90,,,,,0,"percent of total billed charges","90% of total billed charges",1662.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",3263.25,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",4275,90,,,,,0,"percent of total billed charges","90% of total billed charges",2755,58,,,,,0,"percent of total billed charges","58% of total billed charges",967.58,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",4037.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",967.58,4275,
LITHOTRIPSY,1550590,CDM,790,RC,50590,HCPCS,OUTPATIENT,,,26210,20968,,22278.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",6552.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6552.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",6552.5,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",5338.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",,,,,,,0,other,"not separately reimbursable",23589,90,,,,,0,"percent of total billed charges","90% of total billed charges",9173.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",18006.27,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",23589,90,,,,,0,"percent of total billed charges","90% of total billed charges",15201.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",5338.98,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",22278.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",2000,23589,
"GROUP PSYCOTHERAPY/ 1 HR",9090853,CDM,900,RC,90853,HCPCS,OUTPATIENT,,,350,280,,297.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",109.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",197.75,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",85.73,102,,,,,0,"fee schedule","102% of CMS OPPS rate",315,90,,,,,0,"percent of total billed charges","90% of total billed charges",122.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",240.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",75.65,90,,,,,0,"fee schedule","90% of CMS OPPS rate",203,58,,,,,0,"percent of total billed charges","58% of total billed charges",71.3,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",84.05,100,,,,,0,"fee schedule","100% of CMS OPPS rate",71.3,315,
"PSYCHOTHERAPY 1 HR W/PATIENT",9090837,CDM,900,RC,90837,HCPCS,OUTPATIENT,,,605,484,,514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.8,130,,,,,0,"fee schedule","130% of CMS OPPS rate",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",148.91,102,,,,,0,"fee schedule","102% of CMS OPPS rate",544.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",415.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.4,90,,,,,0,"fee schedule","90% of CMS OPPS rate",350.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",123.24,544.5,
"PSYCHOTHERAPY 30 MIN W/PATIENT",9090832,CDM,900,RC,90832,HCPCS,OUTPATIENT,,,300,240,,255,85,,,,,0,"percent of total billed charges","85% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.8,130,,,,,0,"fee schedule","130% of CMS OPPS rate",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",169.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",148.91,102,,,,,0,"fee schedule","102% of CMS OPPS rate",270,90,,,,,0,"percent of total billed charges","90% of total billed charges",105,35,,,,,0,"percent of total billed charges","35% of total billed charges",206.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.4,90,,,,,0,"fee schedule","90% of CMS OPPS rate",174,58,,,,,0,"percent of total billed charges","58% of total billed charges",61.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",61.11,270,
"PSYCHOTHERAPY 45 MIN W/PATIENT",9090834,CDM,900,RC,90834,HCPCS,OUTPATIENT,,,605,484,,514.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",189.8,130,,,,,0,"fee schedule","130% of CMS OPPS rate",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",341.83,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",148.91,102,,,,,0,"fee schedule","102% of CMS OPPS rate",544.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",211.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",415.64,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",131.4,90,,,,,0,"fee schedule","90% of CMS OPPS rate",350.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",123.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",145.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",123.24,544.5,
"ACTIVITY THERAPY 45 MIN",9000176,CDM,904,RC,,,OUTPATIENT,,,275,220,,233.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",68.75,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",155.38,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",96.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",188.93,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",247.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",159.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",56.02,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",56.02,247.5,
"POLYSOM 6/>YRS CPAP 4/>PARM",1595811,CDM,920,RC,95811,HCPCS,OUTPATIENT,,,4120,3296,,3502,85,,,,,0,"percent of total billed charges","85% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1201.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",943.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3708,90,,,,,0,"percent of total billed charges","90% of total billed charges",1442,35,,,,,0,"percent of total billed charges","35% of total billed charges",2830.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",832.08,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2389.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",832.08,3708,
"POLYSOMNOGRAPHY 6YRS OR OLDER",1595810,CDM,920,RC,95810,HCPCS,OUTPATIENT,,,4120,3296,,3502,85,,,,,0,"percent of total billed charges","85% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1201.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",943.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3708,90,,,,,0,"percent of total billed charges","90% of total billed charges",1442,35,,,,,0,"percent of total billed charges","35% of total billed charges",2830.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",832.08,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2389.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",832.08,3708,
"POLYSOMNOGRAPHY YOUNGER 6YRS",1595782,CDM,920,RC,95782,HCPCS,OUTPATIENT,,,4120,3296,,3502,85,,,,,0,"percent of total billed charges","85% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1201.89,130,,,,,0,"fee schedule","130% of CMS OPPS rate",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",2000,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",943.02,102,,,,,0,"fee schedule","102% of CMS OPPS rate",3708,90,,,,,0,"percent of total billed charges","90% of total billed charges",1442,35,,,,,0,"percent of total billed charges","35% of total billed charges",2830.44,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",832.08,90,,,,,0,"fee schedule","90% of CMS OPPS rate",2389.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",839.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,,,,0,other,"not separately reimbursable",924.54,100,,,,,0,"fee schedule","100% of CMS OPPS rate",832.08,3708,
"US AORTIC LOW EXT-LEFT",4600016,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,4.27,4.27,4.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US AORTIC LOW EXT-RIGHT",4693926,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,4.27,4.27,4.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US ARTERIAL LOWER EXT LEFT",4993926,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,4.27,4.27,4.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US ARTERIAL LOWER EXT RIGHT",4993927,CDM,921,RC,93926,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,4.27,4.27,4.27,"1 through 10","percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,"1 through 10","fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US ARTERIAL LOWER EXT/BIL",4693925,CDM,921,RC,93925,HCPCS,OUTPATIENT,,,1600,1280,,1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",904,56.5,,6.98,6.98,6.98,"1 through 10","percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",904,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1440,90,,,,,0,"percent of total billed charges","90% of total billed charges",560,35,,,,,0,"percent of total billed charges","35% of total billed charges",1099.2,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",928,58,,,,,0,"percent of total billed charges","58% of total billed charges",325.92,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1360,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1440,
"US ARTERIAL UPPER EXT BIL",4693930,CDM,921,RC,93930,HCPCS,OUTPATIENT,,,1595,1276,,1355.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",324.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1435.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",558.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1095.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",925.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",324.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1355.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1435.5,
"US ARTERIAL UPPER EXT LEFT",4600017,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US ARTERIAL UPPER EXT RIGHT",4693931,CDM,921,RC,93931,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,972,
"US ARTERIAL-SCROTAL",4693975,CDM,921,RC,93975,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,972,
"US ARTERIAL-SCROTAL-LIMITED",4693976,CDM,921,RC,93976,HCPCS,OUTPATIENT,,,905,724,,769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",511.33,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",814.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",316.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",621.74,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",524.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",184.35,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",769.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,814.5,
"US AV GRAFT IMAGE",4693990,CDM,921,RC,93990,HCPCS,OUTPATIENT,,,970,776,,824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",197.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",548.05,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",873,90,,,,,0,"percent of total billed charges","90% of total billed charges",339.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",666.39,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",562.6,58,,,,,0,"percent of total billed charges","58% of total billed charges",197.59,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",824.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,873,
"US BIL PHYSOLOGIC SEG AR",4600013,CDM,921,RC,93923,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,972,
"US BILAT ARTERIAL LOW EX",4600015,CDM,921,RC,93925,HCPCS,OUTPATIENT,,,1595,1276,,1355.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",324.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",901.18,56.5,,6.98,6.98,6.98,"1 through 10","percent of total billed charges","50.56% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",901.18,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1435.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",558.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1095.77,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",925.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",324.9,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1355.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1435.5,
"US CAROTID IMAGING-BIL",4693880,CDM,921,RC,93880,HCPCS,OUTPATIENT,,,1100,880,,935,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",224.07,20.37,,138.30,138.30,138.30,"1 through 10","percent of total billed charges","20.37% of total billed charges",621.5,56.5,,43.94,27.83,271.42,"1 through 10","percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",621.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",990,90,,,,,0,"percent of total billed charges","90% of total billed charges",385,35,,,,,0,"percent of total billed charges","35% of total billed charges",755.7,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",638,58,,,,,0,"percent of total billed charges","58% of total billed charges",224.07,20.37,,175.62,175.62,175.62,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,32,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",935,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,990,
"US CAROTID UNI LEFT",4600011,CDM,921,RC,93882,HCPCS,OUTPATIENT,,,1300,1040,,1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",734.5,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1170,90,,,,,0,"percent of total billed charges","90% of total billed charges",455,35,,,,,0,"percent of total billed charges","35% of total billed charges",893.1,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",754,58,,,,,0,"percent of total billed charges","58% of total billed charges",264.81,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1105,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,1170,
"US DUP AORTA/IVC/COMPLET",4693978,CDM,921,RC,93978,HCPCS,OUTPATIENT,,,1645,1316,,1398.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",335.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",929.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",929.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",929.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",929.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1480.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",575.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1130.12,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",954.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",335.09,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1398.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1480.5,
"US DUPLEX ART ABD LTD",4600022,CDM,921,RC,93976,HCPCS,OUTPATIENT,,,895,716,,760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",505.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",805.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",313.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",614.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",519.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",182.31,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",760.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,805.5,
"US DUPLX AORTA/IVC/LIMIT",4693979,CDM,921,RC,93979,HCPCS,OUTPATIENT,,,1080,864,,918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",610.2,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",972,90,,,,,0,"percent of total billed charges","90% of total billed charges",378,35,,,,,0,"percent of total billed charges","35% of total billed charges",741.96,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,90,,,,,0,"fee schedule","90% of CMS OPPS rate",626.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",220,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",918,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.97,972,
"US DUPLX SCAN PENILE VES",4693980,CDM,921,RC,93980,HCPCS,OUTPATIENT,,,1895,1516,,1610.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",386.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",1070.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1070.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1070.68,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",1070.68,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1705.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",663.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",1301.87,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1099.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",386.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1610.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,1705.5,
"US DVT  LEFT LOWER",4600939,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",186.39,20.37,,21.97,21.97,21.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",516.98,56.5,,95.66,18.62,506.82,11,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,146.08,146.08,146.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,28,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,823.5,
"US DVT  LEFT UPPER",4600020,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",186.39,20.37,,21.97,21.97,21.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",516.98,56.5,,95.66,18.62,506.82,11,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,146.08,146.08,146.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,28,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,823.5,
"US DVT  RIGHT LOWER",4600971,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",186.39,20.37,,21.97,21.97,21.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",516.98,56.5,,95.66,18.62,506.82,11,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,146.08,146.08,146.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,28,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,823.5,
"US DVT BILAT LOWER",4693970,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,1745,1396,,1483.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",355.46,20.37,,275.28,275.28,275.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",985.93,56.5,,36.47,26.01,439.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",985.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",985.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",985.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1570.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",610.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1198.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1012.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",355.46,20.37,,6.09,6.09,6.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1483.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1570.5,
"US DVT BILAT UPPER",4600018,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,1745,1396,,1483.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",355.46,20.37,,275.28,275.28,275.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",985.93,56.5,,36.47,26.01,439.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",985.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",985.93,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",985.93,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1570.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",610.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",1198.82,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",1012.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",355.46,20.37,,6.09,6.09,6.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1483.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1570.5,
"US DVT RIGHT UPPER",4600021,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,915,732,,777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",186.39,20.37,,21.97,21.97,21.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",516.98,56.5,,95.66,18.62,506.82,11,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",516.98,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",823.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",320.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",628.61,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",530.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",186.39,20.37,,146.08,146.08,146.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,28,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",777.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,823.5,
"US EXTREMITY VEINS-LTD",4693971,CDM,921,RC,93971,HCPCS,OUTPATIENT,,,1340,1072,,1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",125.62,130,,,,,0,"fee schedule","130% of CMS OPPS rate",272.96,20.37,,21.97,21.97,21.97,"1 through 10","percent of total billed charges","20.37% of total billed charges",757.1,56.5,,95.66,18.62,506.82,11,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",757.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",98.56,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1206,90,,,,,0,"percent of total billed charges","90% of total billed charges",469,35,,,,,0,"percent of total billed charges","35% of total billed charges",920.58,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",777.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",272.96,20.37,,146.08,146.08,146.08,"1 through 10","percent of total billed charges","20.37% of total billed charges",96.63,100,,75.76,75.76,75.76,28,"fee schedule","100% of CMS OPPS rate",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1139,85,,,,,0,"percent of total billed charges","85% of total billed charges",96.63,100,,,,,0,"fee schedule","100% of CMS OPPS rate",86.96,1206,
"US IMPOT PENILE STUDY PLETHYSMOGRAPHY",4654240,CDM,921,RC,54240,HCPCS,OUTPATIENT,,,980,784,,833,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",367.87,130,,,,,0,"fee schedule","130% of CMS OPPS rate",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",553.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",288.63,102,,,,,0,"fee schedule","102% of CMS OPPS rate",882,90,,,,,0,"percent of total billed charges","90% of total billed charges",343,35,,,,,0,"percent of total billed charges","35% of total billed charges",673.26,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",254.67,90,,,,,0,"fee schedule","90% of CMS OPPS rate",568.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",199.63,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",833,85,,,,,0,"percent of total billed charges","85% of total billed charges",282.97,100,,,,,0,"fee schedule","100% of CMS OPPS rate",199.63,882,
"US PHYS EXT VENOUS/CMPLT-BIL",4693965,CDM,921,RC,93970,HCPCS,OUTPATIENT,,,810,648,,688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",165,20.37,,275.28,275.28,275.28,"1 through 10","percent of total billed charges","20.37% of total billed charges",457.65,56.5,,36.47,26.01,439.33,"1 through 10","percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",457.65,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",729,90,,,,,0,"percent of total billed charges","90% of total billed charges",283.5,35,,,,,0,"percent of total billed charges","35% of total billed charges",556.47,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",469.8,58,,,,,0,"percent of total billed charges","58% of total billed charges",165,20.37,,6.09,6.09,6.09,"1 through 10","percent of total billed charges","20.37% of total billed charges",219.66,100,,172.21,172.21,172.21,"1 through 10","fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",688.5,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",165,729,
"US PHYS LOWER EXT/REST-BIL",4693924,CDM,921,RC,93924,HCPCS,OUTPATIENT,,,1415,1132,,1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",799.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",799.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",799.48,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",799.48,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1273.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",495.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",972.11,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",820.7,58,,,,,0,"percent of total billed charges","58% of total billed charges",288.24,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1202.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,1273.5,
"US PHYS UP/LOW ART/1 LVL-BIL ABI",4600012,CDM,921,RC,93922,HCPCS,OUTPATIENT,,,1380,1104,,1173,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",152.27,130,,,,,0,"fee schedule","130% of CMS OPPS rate",281.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",779.7,56.5,,63.45,21.46,105.44,"1 through 10","percent of total billed charges","50.56% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",779.7,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",119.47,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1242,90,,,,,0,"percent of total billed charges","90% of total billed charges",483,35,,,,,0,"percent of total billed charges","35% of total billed charges",948.06,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,90,,,,,0,"fee schedule","90% of CMS OPPS rate",800.4,58,,,,,0,"percent of total billed charges","58% of total billed charges",281.11,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",117.13,100,,91.84,91.84,91.84,"1 through 10","fee schedule","100% of CMS OPPS rate",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1173,85,,,,,0,"percent of total billed charges","85% of total billed charges",117.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",105.42,1242,
"US PHYS UP/LOW ART/MULTI-BIL",4693923,CDM,921,RC,93923,HCPCS,OUTPATIENT,,,1355,1084,,1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",765.58,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1219.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",474.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",930.89,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",785.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",276.01,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1151.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,1219.5,
"US PHYSL SEG EXERCISE-BIL",4600014,CDM,921,RC,93924,HCPCS,OUTPATIENT,,,1255,1004,,1066.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",184.82,130,,,,,0,"fee schedule","130% of CMS OPPS rate",255.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",709.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",709.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",709.08,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",709.08,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",145.01,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1129.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",439.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",862.19,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,90,,,,,0,"fee schedule","90% of CMS OPPS rate",727.9,58,,,,,0,"percent of total billed charges","58% of total billed charges",255.64,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1066.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",142.18,100,,,,,0,"fee schedule","100% of CMS OPPS rate",127.96,1129.5,
"US VASCULAR-AORTA-IVC-ILIAC-COMPLETE",4600023,CDM,921,RC,93978,HCPCS,OUTPATIENT,,,1235,988,,1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",285.55,130,,,,,0,"fee schedule","130% of CMS OPPS rate",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",697.78,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",224.04,102,,,,,0,"fee schedule","102% of CMS OPPS rate",1111.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",432.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",848.45,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,90,,,,,0,"fee schedule","90% of CMS OPPS rate",716.3,58,,,,,0,"percent of total billed charges","58% of total billed charges",251.57,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1049.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",219.66,100,,,,,0,"fee schedule","100% of CMS OPPS rate",197.68,1111.5,
"CP BEHAV CHNG SMOKING >10 MIN",5899407,CDM,942,RC,99407,HCPCS,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.6,102,,,,,0,"fee schedule","102% of CMS OPPS rate",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,157.5,
"CP BEHAV CHNG SMOKING 3-10 MIN",5899406,CDM,942,RC,99406,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",28.52,20.37,,22.78,22.23,23.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,25.85,25.85,25.85,"1 through 10","percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.6,102,,,,,0,"fee schedule","102% of CMS OPPS rate",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,30.07,30.07,30.07,"1 through 10","percent of total billed charges","68.7% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",27.07,100,,26.53,26.53,26.53,"1 through 10","fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,126,
"GEST DIABETES MNGT",6000620,CDM,942,RC,G0108,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"IND THERAPEUTIC DIET CONS",6000848,CDM,942,RC,97802,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",35,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",28.52,126,
"INDIV DM/HYPO SELF MGMT",6000844,CDM,942,RC,,,OUTPATIENT,,,245,196,,208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",61.25,25,,,,,0,"percent of total billed charges","25% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",138.43,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",85.75,35,,,,,0,"percent of total billed charges","35% of total billed charges",168.32,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",,,,,,,0,other,"not separately reimbursable",220.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",142.1,58,,,,,0,"percent of total billed charges","58% of total billed charges",49.91,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",208.25,85,,,,,0,"percent of total billed charges","85% of total billed charges",,,,,,,0,other,"not separately reimbursable",49.91,220.5,
"SMOKING CESSATION",5500007,CDM,942,RC,99406,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",28.52,20.37,,22.78,22.23,23.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,25.85,25.85,25.85,"1 through 10","percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.6,102,,,,,0,"fee schedule","102% of CMS OPPS rate",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,30.07,30.07,30.07,"1 through 10","percent of total billed charges","68.7% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",27.07,100,,26.53,26.53,26.53,"1 through 10","fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,126,
"SMOKING CESSATION COUNSELING >10 MINUTES",2099407,CDM,942,RC,99407,HCPCS,OUTPATIENT,,,175,140,,148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",98.88,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.6,102,,,,,0,"fee schedule","102% of CMS OPPS rate",157.5,90,,,,,0,"percent of total billed charges","90% of total billed charges",61.25,35,,,,,0,"percent of total billed charges","35% of total billed charges",120.23,68.7,,,,,0,"percent of total billed charges","68.7% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",101.5,58,,,,,0,"percent of total billed charges","58% of total billed charges",35.65,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",148.75,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,157.5,
"SMOKING CESSATION COUNSELING 3-10 MINUTE",2099406,CDM,942,RC,99406,HCPCS,OUTPATIENT,,,140,112,,119,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",35.18,130,,,,,0,"fee schedule","130% of CMS OPPS rate",28.52,20.37,,22.78,22.23,23.33,"1 through 10","percent of total billed charges","20.37% of total billed charges",79.1,56.5,,25.85,25.85,25.85,"1 through 10","percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","50.56% of total billed charges",79.1,56.5,,,,,0,"percent of total billed charges","56.50% of total billed charges",27.6,102,,,,,0,"fee schedule","102% of CMS OPPS rate",126,90,,,,,0,"percent of total billed charges","90% of total billed charges",49,35,,,,,0,"percent of total billed charges","35% of total billed charges",96.18,68.7,,30.07,30.07,30.07,"1 through 10","percent of total billed charges","68.7% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,90,,,,,0,"fee schedule","90% of CMS OPPS rate",81.2,58,,,,,0,"percent of total billed charges","58% of total billed charges",28.52,20.37,,,,,0,"percent of total billed charges","20.37% of total billed charges",27.07,100,,26.53,26.53,26.53,"1 through 10","fee schedule","100% of CMS OPPS rate",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",119,85,,,,,0,"percent of total billed charges","85% of total billed charges",27.07,100,,,,,0,"fee schedule","100% of CMS OPPS rate",24.36,126,
"INITIAL HOSP CARE DAY 50 MIN",2099222,CDM,960,RC,99222,HCPCS,OUTPATIENT,,,615,492,,,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,,,,,0,other,"not separately reimbursable",,,
"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC",1,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",222522.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",178018.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",171171.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",162612.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",171171.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",222522.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",171171.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,222522.86,
"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC",2,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",90819.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",72655.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",69861.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",66368.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",69861.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",90819.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",69861.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,90819.42,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",168879.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",135103.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",129907.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",123412.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",129907.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",168879.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",129907.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,168879.98,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",110699.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",88559.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",85153.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",80895.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",85153.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",110699.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",85153.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,110699.49,
"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT",5,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",82761.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",66208.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",63662.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",60479.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",63662.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",82761.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",63662.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,82761.21,
"LIVER TRANSPLANT WITHOUT MCC",6,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37996.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30397.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29227.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27766.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",29227.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37996.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",29227.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37996.35,
"LUNG TRANSPLANT",7,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",103588.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",82871.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",79683.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",75699.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",79683.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",103588.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",79683.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,103588.86,
"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT",8,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",45630.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36504.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35100.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33345.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",35100.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",45630.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",35100.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,45630.87,
"PANCREAS TRANSPLANT",10,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",58027.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46421.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44636.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42404.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",44636.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",58027.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",44636.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,58027.11,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44443.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35554.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34187.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32477.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34187.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44443.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34187.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,44443.41,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34674.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27739.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26672.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25339.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26672.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34674.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26672.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34674.59,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24147.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19318.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18575.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17646.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18575.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24147.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18575.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24147.53,
"ALLOGENEIC BONE MARROW TRANSPLANT",14,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",96232.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",76986.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",74025.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",70324.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",74025.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",96232.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",74025.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,96232.86,
"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC",16,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",48195.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38556.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37073.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35220.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",37073.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48195.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",37073.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,48195.97,
"AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC",17,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44271.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35417.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34054.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32352.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34054.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44271.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34054.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,44271.4,
"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES",18,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",342129.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",273703.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",263176.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",250017.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",263176.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",342129.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",263176.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,342129.07,
"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS",19,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",57702.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46162.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44386.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42167.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",44386.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",57702.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",44386.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,57702.83,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC",20,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",63495.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",50796.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",48842.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",46400.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",48842.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",63495.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",48842.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,63495.78,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC",21,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43178.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34542.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33214.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31553.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",33214.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",43178.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",33214.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,43178.6,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC",22,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26479.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21183.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20369.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19350.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20369.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26479.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20369.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26479.86,
"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR",23,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46622.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37298.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35863.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34070.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",35863.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",46622.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",35863.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,46622.67,
"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC",24,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32275.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25820.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24827.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23585.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",24827.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32275.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",24827.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,32275.19,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC",25,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37283.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29827.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28679.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27245.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28679.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37283.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28679.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37283.87,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC",26,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25941.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20753.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19955.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18957.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19955.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25941.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19955.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25941.75,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC",27,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21315.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17052.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16396.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15576.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16396.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21315.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16396.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21315.75,
"SPINAL PROCEDURES WITH MCC",28,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",48816.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39052.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37550.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35673.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",37550.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48816.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",37550.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,48816.13,
"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS",29,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28327.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22662.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21790.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20701.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21790.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28327.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21790.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28327.74,
"SPINAL PROCEDURES WITHOUT CC/MCC",30,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18730.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14984.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14407.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13687.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14407.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18730.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14407.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18730.14,
"VENTRICULAR SHUNT PROCEDURES WITH MCC",31,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36761.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29409.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28278.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26864.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28278.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36761.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28278.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,36761.54,
"VENTRICULAR SHUNT PROCEDURES WITH CC",32,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18223.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14578.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14018.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13317.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14018.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18223.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14018.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18223.6,
"VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC",33,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14530.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11624.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11177.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10618.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11177.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14530.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11177.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14530.22,
"CAROTID ARTERY STENT PROCEDURES WITH MCC",34,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31950.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25560.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24577.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23348.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",24577.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31950.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",24577.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,31950.13,
"CAROTID ARTERY STENT PROCEDURES WITH CC",35,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20271.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16216.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15593.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14813.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15593.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20271.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15593.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20271.1,
"CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC",36,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16738.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13390.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12875.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12232.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12875.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16738.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12875.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16738.67,
"EXTRACRANIAL PROCEDURES WITH MCC",37,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27384.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21907.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21065.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20012.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21065.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27384.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21065.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,27384.86,
"EXTRACRANIAL PROCEDURES WITH CC",38,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14212.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11369.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10932.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10385.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10932.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14212.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10932.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14212.24,
"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC",39,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10684.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8547.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8218.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7807.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8218.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10684.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8218.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10684.54,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31875.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25500.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24519.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23293.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",24519.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31875.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",24519.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,31875.16,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18757.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15006.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14429.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13707.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14429.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18757.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14429.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18757.77,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15041.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12033.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11570.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10991.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11570.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15041.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11570.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15041.49,
"SPINAL DISORDERS AND INJURIES WITH CC/MCC",52,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15701.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12560.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12077.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11473.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12077.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15701.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12077.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15701.11,
"SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC",53,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9135.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7308.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7027.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6676.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7027.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9135.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7027.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9135.7,
"NERVOUS SYSTEM NEOPLASMS WITH MCC",54,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13457.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10765.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10351.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9834.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10351.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13457.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10351.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13457.15,
"NERVOUS SYSTEM NEOPLASMS WITHOUT MCC",55,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9454.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7563.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7272.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6909.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7272.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9454.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7272.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9454.47,
"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC",56,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19739.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15791.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15184.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14424.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15184.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19739.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15184.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19739.3,
"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC",57,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11632.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9305.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8947.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8500.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8947.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11632.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8947.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11632.15,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC",58,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14897.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11918.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11459.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10886.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11459.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14897.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11459.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14897.9,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC",59,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11200.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8960.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8615.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8185.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8615.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11200.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8615.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11200.55,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC",60,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8667.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6933.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6666.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6333.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6666.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8667.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6666.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8667.04,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23163.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18530.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17818.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16927.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17818.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23163.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17818.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23163.63,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15274.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12219.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11749.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11161.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11749.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15274.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11749.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15274.25,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12485.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9988.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9604.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9124.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9604.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12485.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9604.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12485.86,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC",64,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17276.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13821.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13289.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12625.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13289.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17276.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13289.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17276.78,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS",65,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9381.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7504.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7216.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6855.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7216.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9381.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7216.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9381.1,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC",66,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6809.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5447.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5238.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4976.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5238.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6809.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5238.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6809.69,
"PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC",67,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12997.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10398.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9998.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9498.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9998.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12997.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9998.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12997.93,
"PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC",68,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8229.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6583.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6330.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6014.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6330.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8229.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6330.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8229.91,
"TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC",69,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7712.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6169.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5932.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5635.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5932.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7712.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5932.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7712.33,
"OTHER CEREBROVASCULAR DISORDERS WITH MCC",70,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14545.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11636.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11188.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10629.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11188.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14545.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11188.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14545.19,
"OTHER CEREBROVASCULAR DISORDERS WITH CC",71,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9504.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7603.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7311.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6945.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7311.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9504.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7311.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9504.96,
"OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC",72,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7376.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5900.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5674,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5390.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5674,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7376.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5674,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7376.2,
"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC",73,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14067.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11254.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10821.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10280.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10821.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14067.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10821.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14067.85,
"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC",74,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9542.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7634.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7340.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6973.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7340.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9542.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7340.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9542.83,
"VIRAL MENINGITIS WITH CC/MCC",75,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16539.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13231.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12722.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12086.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12722.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16539.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12722.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16539.06,
"VIRAL MENINGITIS WITHOUT CC/MCC",76,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7920.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6336.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6092.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5788.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6092.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7920.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6092.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7920.61,
"NONTRAUMATIC STUPOR AND COMA WITH MCC",80,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15690.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12552.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12069.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11466.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12069.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15690.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12069.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15690.84,
"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC",81,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8476.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6780.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6520.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6194.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6520.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8476.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6520.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8476.09,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC",82,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19443.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15554.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14956.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14208.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14956.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19443.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14956.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19443.42,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC",83,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12422.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9938.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9555.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9078.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9555.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12422.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9555.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12422.75,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC",84,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8951.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7160.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6885.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6541.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6885.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8951.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6885.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8951.07,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC",85,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19335.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15468.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14873.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14129.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14873.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19335.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14873.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19335.32,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC",86,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11688.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9350.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8990.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8541.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8990.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11688.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8990.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11688.17,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC",87,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8626.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6901.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6636,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6304.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6636,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8626.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6636,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8626.8,
"CONCUSSION WITH MCC",88,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12075.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9660.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9288.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8824.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9288.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12075.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9288.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12075.58,
"CONCUSSION WITH CC",89,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10077.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8062.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7752.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7364.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7752.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10077.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7752.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10077.8,
"CONCUSSION WITHOUT CC/MCC",90,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7904.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6323.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6080.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5776.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6080.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7904.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6080.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7904.83,
"OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC",91,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15266.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12213.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11743.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11156.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11743.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15266.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11743.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15266.37,
"OTHER DISORDERS OF NERVOUS SYSTEM WITH CC",92,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9481.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7585.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7293.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6928.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7293.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9481.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7293.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9481.3,
"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC",93,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7692.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6154.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5917.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5621.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5917.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7692.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5917.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7692.59,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC",94,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29178.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23342.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22444.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21322.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22444.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29178.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22444.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29178.31,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC",95,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21759.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17407.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16738.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15901.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16738.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21759.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16738.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21759.97,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC",96,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21759.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17407.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16738.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15901.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16738.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21759.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16738.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21759.97,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC",97,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29907.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23925.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23005.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21855.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23005.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29907.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23005.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29907.36,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC",98,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19516.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15613.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15012.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14262.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15012.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19516.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15012.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19516.8,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC",99,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12159.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9727.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9353.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8885.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9353.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12159.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9353.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12159.21,
"SEIZURES WITH MCC",100,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16691.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13353.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12839.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12197.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12839.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16691.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12839.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16691.32,
"SEIZURES WITHOUT MCC",101,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8531.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6825.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6562.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6234.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6562.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8531.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6562.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8531.33,
"HEADACHES WITH MCC",102,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10253.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8203,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7887.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7493.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7887.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10253.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7887.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10253.75,
"HEADACHES WITHOUT MCC",103,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8008.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6406.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6160.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5852.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6160.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8008.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6160.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8008.21,
"ORBITAL PROCEDURES WITH CC/MCC",113,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19960.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15968.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15354.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14586.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15354.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19960.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15354.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19960.23,
"ORBITAL PROCEDURES WITHOUT CC/MCC",114,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12085.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9668.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9296.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8831.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9296.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12085.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9296.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12085.05,
"EXTRAOCULAR PROCEDURES EXCEPT ORBIT",115,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13520.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10816.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10400.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9880.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10400.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13520.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10400.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13520.27,
"INTRAOCULAR PROCEDURES WITH CC/MCC",116,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15675.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12540.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12058.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11455.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12058.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15675.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12058.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15675.87,
"INTRAOCULAR PROCEDURES WITHOUT CC/MCC",117,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9969.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7975.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7668.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7285.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7668.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9969.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7668.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9969.69,
"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC",121,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10588.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8470.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8144.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7737.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8144.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10588.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8144.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10588.28,
"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC",122,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7609.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6087.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5853.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5560.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5853.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7609.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5853.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7609.75,
"NEUROLOGICAL EYE DISORDERS",123,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7710.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6168.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5931.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5634.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5931.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7710.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5931.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7710.74,
"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT",124,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11849.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9479.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9114.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8658.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9114.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11849.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9114.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11849.14,
"OTHER DISORDERS OF THE EYE WITHOUT MCC",125,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7467.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5974.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5744.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5457.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5744.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7467.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5744.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7467.73,
"SINUS AND MASTOID PROCEDURES WITH CC/MCC",135,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18531.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14825.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14254.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13542.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14254.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18531.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14254.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18531.32,
"SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC",136,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9420.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7536.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7246.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6884.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7246.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9420.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7246.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9420.54,
"MOUTH PROCEDURES WITH CC/MCC",137,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13191.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10553,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10147.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9639.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10147.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13191.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10147.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13191.26,
"MOUTH PROCEDURES WITHOUT CC/MCC",138,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8401.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6721.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6463.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6139.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6463.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8401.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6463.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8401.93,
"SALIVARY GLAND PROCEDURES",139,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11159.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8927.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8584.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8155.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8584.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11159.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8584.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11159.54,
"MAJOR HEAD AND NECK PROCEDURES WITH MCC",140,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35063.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28050.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26971.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25623.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26971.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35063.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26971.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,35063.57,
"MAJOR HEAD AND NECK PROCEDURES WITH CC",141,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18618.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14895.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14322.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13606.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14322.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18618.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14322.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18618.89,
"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC",142,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14005.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11204.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10773.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10234.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10773.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14005.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10773.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14005.51,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30970.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24776.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23823.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22632.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23823.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30970.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23823.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30970.95,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15082.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12066.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11601.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11021.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11601.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15082.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11601.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15082.52,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10895.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8716.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8381.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7962.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8381.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10895.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8381.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10895.99,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18116.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14493.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13935.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13238.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13935.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18116.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13935.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18116.28,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11442,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9153.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8801.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8361.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8801.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11442,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8801.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11442,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7698.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6159.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5922.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5626.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5922.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7698.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5922.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7698.91,
DYSEQUILIBRIUM,149,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7339.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5871.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5646.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5363.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5646.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7339.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5646.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7339.9,
"EPISTAXIS WITH MCC",150,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11915.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9532.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9165.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8707.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9165.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11915.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9165.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11915.41,
"EPISTAXIS WITHOUT MCC",151,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7201.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5760.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5539.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5262.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5539.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7201.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5539.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7201.04,
"OTITIS MEDIA AND URI WITH MCC",152,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10737.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8589.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8259.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7846.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8259.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10737.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8259.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10737.4,
"OTITIS MEDIA AND URI WITHOUT MCC",153,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7234.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5787.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5564.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5286.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5564.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7234.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5564.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7234.18,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13745.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10996.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10573.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10045.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10573.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13745.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10573.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13745.93,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8641,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6912.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6646.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6314.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6646.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8641,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6646.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8641,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6862.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5490.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5278.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5014.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5278.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6862.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5278.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6862.56,
"DENTAL AND ORAL DISEASES WITH MCC",157,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14955.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11964.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11504.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10929.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11504.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14955.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11504.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14955.49,
"DENTAL AND ORAL DISEASES WITH CC",158,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8588.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6870.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6606.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6275.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6606.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8588.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6606.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8588.13,
"DENTAL AND ORAL DISEASES WITHOUT CC/MCC",159,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6999.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5599.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5384.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5115.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5384.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6999.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5384.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6999.84,
"MAJOR CHEST PROCEDURES WITH MCC",163,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36771.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29417.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28286,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26871.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28286,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36771.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28286,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,36771.8,
"MAJOR CHEST PROCEDURES WITH CC",164,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21324.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17059.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16403.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15583.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16403.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21324.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16403.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21324.43,
"MAJOR CHEST PROCEDURES WITHOUT CC/MCC",165,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16513.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13210.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12702.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12067.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12702.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16513.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12702.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16513.02,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC",166,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30900.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24720.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23769.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22581.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23769.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30900.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23769.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30900.73,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC",167,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15638.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12511.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12029.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11428.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12029.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15638.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12029.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15638.78,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",168,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12190.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9752.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9377.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8908.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9377.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12190.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9377.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12190.78,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM",173,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24893.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19915.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19149.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18191.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19149.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24893.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19149.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24893.95,
"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE",175,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12247.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9798.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9421.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8950.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9421.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12247.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9421.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12247.59,
"PULMONARY EMBOLISM WITHOUT MCC",176,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7761.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6209,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5970.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5671.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5970.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7761.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5970.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7761.25,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC",177,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13739.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10991.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10568.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10040.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10568.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13739.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10568.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13739.61,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC",178,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9110.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7288.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7008.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6657.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7008.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9110.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7008.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9110.45,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC",179,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7366.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5893.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5666.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5383.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5666.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7366.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5666.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7366.72,
"RESPIRATORY NEOPLASMS WITH MCC",180,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15343.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12274.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11802.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11212.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11802.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15343.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11802.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15343.68,
"RESPIRATORY NEOPLASMS WITH CC",181,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9860.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7888.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7584.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7205.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7584.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9860.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7584.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9860.02,
"RESPIRATORY NEOPLASMS WITHOUT CC/MCC",182,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7357.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5885.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5659.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5376.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5659.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7357.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5659.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7357.26,
"MAJOR CHEST TRAUMA WITH MCC",183,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13480.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10784.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10369.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9851.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10369.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13480.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10369.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13480.82,
"MAJOR CHEST TRAUMA WITH CC",184,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9805.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7844.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7542.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7165.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7542.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9805.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7542.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9805.58,
"MAJOR CHEST TRAUMA WITHOUT CC/MCC",185,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7615.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6092.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5857.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5565.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5857.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7615.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5857.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7615.27,
"PLEURAL EFFUSION WITH MCC",186,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13706.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10965.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10543.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10016.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10543.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13706.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10543.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13706.49,
"PLEURAL EFFUSION WITH CC",187,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9213.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7371.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7087.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6733.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7087.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9213.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7087.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9213.82,
"PLEURAL EFFUSION WITHOUT CC/MCC",188,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7068.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5654.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5437.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5165.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5437.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7068.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5437.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7068.48,
"PULMONARY EDEMA AND RESPIRATORY FAILURE",189,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11157.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8925.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8582.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8153.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8582.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11157.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8582.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11157.17,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC",190,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10149.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8119.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7807.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7417.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7807.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10149.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7807.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10149.59,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC",191,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8061.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6448.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6200.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5890.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6200.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8061.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6200.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8061.07,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC",192,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6475.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5180.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4980.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4731.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4980.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6475.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4980.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6475.14,
"SIMPLE PNEUMONIA AND PLEURISY WITH MCC",193,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11780.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9424.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9061.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8608.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9061.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11780.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9061.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11780.48,
"SIMPLE PNEUMONIA AND PLEURISY WITH CC",194,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7768.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6214.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5975.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5676.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5975.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7768.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5975.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7768.35,
"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC",195,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6368.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5094.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4898.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4653.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4898.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6368.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4898.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6368.62,
"INTERSTITIAL LUNG DISEASE WITH MCC",196,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16299.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13039.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12538.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11911.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12538.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16299.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12538.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16299.97,
"INTERSTITIAL LUNG DISEASE WITH CC",197,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8898.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7118.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6844.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6502.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6844.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8898.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6844.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8898.21,
"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC",198,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7060.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5648.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5431.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5159.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5431.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7060.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5431.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7060.6,
"PNEUMOTHORAX WITH MCC",199,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15328.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12262.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11791.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11201.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11791.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15328.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11791.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15328.7,
"PNEUMOTHORAX WITH CC",200,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10083.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8066.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7756.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7368.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7756.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10083.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7756.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10083.31,
"PNEUMOTHORAX WITHOUT CC/MCC",201,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7051.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5641.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5424.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5153.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5424.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7051.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5424.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7051.92,
"BRONCHITIS AND ASTHMA WITH CC/MCC",202,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9072.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7258.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6978.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6629.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6978.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9072.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6978.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9072.58,
"BRONCHITIS AND ASTHMA WITHOUT CC/MCC",203,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6696.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5356.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5150.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4893.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5150.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6696.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5150.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6696.07,
"RESPIRATORY SIGNS AND SYMPTOMS",204,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7780.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6224.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5984.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5685.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5984.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7780.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5984.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7780.18,
"OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC",205,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15856.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12685.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12197.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11587.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12197.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15856.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12197.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15856.56,
"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC",206,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8835.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7068.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6796.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6456.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6796.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8835.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6796.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8835.09,
"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS",207,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",52180.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",41744.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40138.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38131.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",40138.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",52180.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",40138.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,52180.51,
"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS",208,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23097.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18477.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17767.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16878.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17767.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23097.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17767.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23097.35,
"COMPLEX AORTIC ARCH PROCEDURES",209,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",90716.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",72573.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",69782.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",66293.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",69782.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",90716.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",69782.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,90716.85,
"CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES",212,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",87208.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",69766.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",67083.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",63728.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",67083.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",87208.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",67083.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,87208.1,
"ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES",213,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46438.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37150.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35721.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33935.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",35721.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",46438.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",35721.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,46438.04,
"OTHER HEART ASSIST SYSTEM IMPLANT",215,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",79972.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",63977.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",61516.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",58441.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",61516.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",79972.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",61516.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,79972.02,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC",216,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",78597.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",62878.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",60459.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",57436.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",60459.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",78597.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",60459.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,78597.56,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC",217,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",53289.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",42631.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40992.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38942.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",40992.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",53289.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",40992.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,53289.85,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC",218,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",53289.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",42631.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40992.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38942.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",40992.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",53289.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",40992.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,53289.85,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC",219,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",61992.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",49594.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",47686.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",45302.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",47686.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",61992.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",47686.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,61992.71,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC",220,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43486.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34789.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33451.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31778.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",33451.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",43486.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",33451.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,43486.33,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC",221,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",41177.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32942.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31675.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30091.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",31675.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",41177.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",31675.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,41177.67,
"OTHER CARDIOTHORACIC PROCEDURES WITH MCC",228,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40445.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32356.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31111.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29556.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",31111.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40445.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",31111.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,40445.46,
"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC",229,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26259.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21007.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20199.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19189.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20199.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26259.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20199.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26259.73,
"CORONARY BYPASS WITH PTCA WITH MCC",231,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",67922.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",54338.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",52248.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",49636.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",52248.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",67922.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",52248.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,67922.96,
"CORONARY BYPASS WITH PTCA WITHOUT MCC",232,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",49244.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39395.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37880.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35986.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",37880.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",49244.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",37880.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,49244.56,
"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC",233,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",61731.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",49385.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",47485.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",45111.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",47485.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",61731.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",47485.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,61731.54,
"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC",234,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44511.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35609.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34239.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32527.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34239.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44511.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34239.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,44511.26,
"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC",235,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",47713.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38171.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36702.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34867.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",36702.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",47713.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",36702.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,47713.87,
"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC",236,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34459.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27567.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26507.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25182.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26507.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34459.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26507.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34459.98,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC",239,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40242.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32194.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30955.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29408.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",30955.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40242.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",30955.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,40242.68,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC",240,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23900.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19120.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18385.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17465.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18385.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23900.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18385.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23900.57,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC",241,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12332.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9866.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9486.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9012.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9486.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12332.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9486.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12332.8,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC",242,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26601.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21281.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20462.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19439.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20462.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26601.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20462.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26601.38,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC",243,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18222.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14578.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14017.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13316.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14017.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18222.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14017.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18222.8,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC",244,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15671.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12536.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12054.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11451.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12054.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15671.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12054.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15671.14,
"AICD GENERATOR PROCEDURES",245,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37407.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29926.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28775.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27336.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28775.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37407.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28775.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37407.75,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC",250,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18629.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14903.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14330.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13614.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14330.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18629.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14330.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18629.94,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC",251,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13201.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10561.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10155.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9647.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10155.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13201.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10155.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13201.51,
"OTHER VASCULAR PROCEDURES WITH MCC",252,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28932.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23146.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22256.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21143.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22256.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28932.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22256.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28932.92,
"OTHER VASCULAR PROCEDURES WITH CC",253,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21889.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17511.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16837.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15996.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16837.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21889.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16837.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21889.36,
"OTHER VASCULAR PROCEDURES WITHOUT CC/MCC",254,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15467.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12374.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11898.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11303.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11898.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15467.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11898.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15467.56,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC",255,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22692.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18154.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17455.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16583.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17455.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22692.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17455.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22692.58,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC",256,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14806.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11845.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11389.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10820.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11389.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14806.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11389.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14806.36,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC",257,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10027.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8021.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7713.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7327.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7713.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10027.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7713.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10027.29,
"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC",258,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26201.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20961.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20154.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19147.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20154.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26201.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20154.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26201.34,
"CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC",259,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17364.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13891.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13357.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12689.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13357.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17364.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13357.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17364.35,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC",260,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27074.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21659.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20826.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19785.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20826.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27074.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20826.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,27074.79,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC",261,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16326.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13060.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11930.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16326.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16326.01,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC",262,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14269.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11415.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10976.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10427.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10976.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14269.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10976.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14269.84,
"VEIN LIGATION AND STRIPPING",263,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25533.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20426.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19640.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18658.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19640.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25533.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19640.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25533.05,
"OTHER CIRCULATORY SYSTEM O.R. PROCEDURES",264,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27767.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22214.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21359.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20291.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21359.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27767.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21359.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,27767.55,
"AICD LEAD PROCEDURES",265,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29957.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23966.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23044.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21892.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23044.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29957.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23044.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29957.85,
"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC",266,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",49763.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39810.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38279.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36365.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",38279.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",49763.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",38279.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,49763.74,
"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC",267,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38973.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31178.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29979.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28480.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",29979.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38973.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",29979.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,38973.16,
"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC",268,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",55677.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44541.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",42828.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40687.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",42828.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",55677.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",42828.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,55677.41,
"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC",269,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34731.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27785.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26716.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25380.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26716.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34731.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26716.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34731.4,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC",270,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43040.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34432.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33108.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31452.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",33108.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",43040.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",33108.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,43040.53,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC",271,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29469.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23575.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22668.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21535.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22668.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29469.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22668.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29469.45,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC",272,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21553.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17242.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16579.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15750.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16579.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21553.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16579.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21553.25,
"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC",273,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33960.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27168.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26123.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24817.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26123.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33960.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26123.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,33960.52,
"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC",274,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27381.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21905.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21062.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20009.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21062.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27381.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21062.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,27381.72,
"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC",275,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",57669.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46135.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44361.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42143.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",44361.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",57669.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",44361.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,57669.69,
"CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR",276,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",48802.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39042.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37540.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35663.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",37540.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48802.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",37540.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,48802.73,
"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC",277,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37850.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30280.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29115.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27659.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",29115.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37850.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",29115.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37850.37,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC",278,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",45327.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36262.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34867.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33124.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34867.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",45327.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34867.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,45327.89,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC",279,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29864.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23891.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22972.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21824.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22972.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29864.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22972.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29864.76,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14066.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11253.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10820.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10279.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10820.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14066.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10820.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14066.26,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8661.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6929.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6662.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6329.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6662.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8661.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6662.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8661.5,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7115.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5692.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5473.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5199.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5473.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7115.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5473.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7115.03,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17038.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13630.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13106.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12451.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13106.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17038.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13106.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17038.49,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6871.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5496.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5285.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5021.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5285.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6871.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5285.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6871.23,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6135.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4908.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4719.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4483.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4719.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6135.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4719.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6135.08,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18869.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15095.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14514.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13788.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14514.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18869.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14514.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18869.02,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9852.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7882.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7579.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7200.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7579.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9852.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7579.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9852.92,
"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC",288,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22762.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18209.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17509.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16633.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17509.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22762.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17509.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22762.01,
"ACUTE AND SUBACUTE ENDOCARDITIS WITH CC",289,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14877.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11901.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11444.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10871.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11444.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14877.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11444.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14877.38,
"ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC",290,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8745.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6996.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6727.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6390.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6727.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8745.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6727.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8745.14,
"HEART FAILURE AND SHOCK WITH MCC",291,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11539.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9231.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8876.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8432.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8876.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11539.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8876.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11539.05,
"HEART FAILURE AND SHOCK WITH CC",292,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8108.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6486.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6237.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5925.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6237.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8108.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6237.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8108.41,
"HEART FAILURE AND SHOCK WITHOUT CC/MCC",293,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5875.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4700.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4519.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4293.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4519.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5875.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4519.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5875.49,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13733.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10986.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10564.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10035.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10564.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13733.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10564.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13733.3,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6412.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5129.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4932.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4685.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4932.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6412.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4932.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6412.02,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5000.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4000.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",3846.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3654.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",3846.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5000.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",3846.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5000.48,
"PERIPHERAL VASCULAR DISORDERS WITH MCC",299,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14291.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11433.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10993.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10444.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10993.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14291.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10993.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14291.93,
"PERIPHERAL VASCULAR DISORDERS WITH CC",300,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9832.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7865.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7563.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7185.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7563.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9832.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7563.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9832.41,
"PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC",301,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7088.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5670.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5452.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5179.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5452.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7088.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5452.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7088.21,
"ATHEROSCLEROSIS WITH MCC",302,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10851.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8680.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8346.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7929.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8346.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10851.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8346.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10851.02,
"ATHEROSCLEROSIS WITHOUT MCC",303,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6721.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5377.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5170.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4911.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5170.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6721.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5170.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6721.31,
"HYPERTENSION WITH MCC",304,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10798.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8639.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8306.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7891.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8306.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10798.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8306.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10798.96,
"HYPERTENSION WITHOUT MCC",305,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7367.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5894.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5667.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5383.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5667.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7367.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5667.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7367.53,
"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC",306,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13842.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11074.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10648.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10116.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10648.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13842.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10648.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13842.99,
"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC",307,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8614.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6891.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6626.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6295.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6626.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8614.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6626.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8614.94,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC",308,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10909.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8727.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8391.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7972.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8391.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10909.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8391.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10909.41,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC",309,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7214.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5771.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5549.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5272.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5549.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7214.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5549.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7214.45,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC",310,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5876.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4701.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4520.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4294.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4520.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5876.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4520.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5876.27,
"ANGINA PECTORIS",311,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6947.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5558.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5344.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5077.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5344.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6947.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5344.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6947.76,
"SYNCOPE AND COLLAPSE",312,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8286.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6629.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6374.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6055.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6374.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8286.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6374.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8286.72,
"CHEST PAIN",313,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7090.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5672.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5454.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5181.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5454.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7090.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5454.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7090.58,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC",314,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17862.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14289.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13740.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13053.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13740.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17862.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13740.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17862.22,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC",315,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9010.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7208.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6930.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6584.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6930.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9010.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6930.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9010.25,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC",316,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6791.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5433.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5224.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4963.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5224.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6791.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5224.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6791.54,
"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION",317,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",54167.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43333.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",41667.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39583.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",41667.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",54167.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",41667.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,54167.24,
"PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE",318,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20521.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16416.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15785.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14996.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15785.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20521.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15785.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20521.22,
"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC",319,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36622.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29298.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28171.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26762.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28171.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36622.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28171.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,36622.68,
"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC",320,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20387.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16310.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15682.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14898.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15682.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20387.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15682.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20387.86,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES",321,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22877.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18301.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17597.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16717.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17597.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22877.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17597.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22877.22,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC",322,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15320.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12256.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11784.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11195.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11784.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15320.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11784.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15320.02,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC",323,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35553.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28442.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27348.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25981.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",27348.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35553.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",27348.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,35553.56,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC",324,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26271.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21017.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20208.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19198.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20208.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26271.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20208.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26271.57,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE",325,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26740.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21392.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20569.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19540.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20569.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26740.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20569.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26740.23,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40761.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32608.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31354.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29786.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",31354.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40761.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",31354.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,40761.07,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20694.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16555.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15919.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15123.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15919.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20694.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15919.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20694.79,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14052.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11241.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10809.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10268.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10809.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14052.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10809.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14052.06,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC",329,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37676.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30141.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28982.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27533.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28982.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37676.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28982.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37676.8,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC",330,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20323.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16259.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15633.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14852.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15633.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20323.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15633.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20323.97,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC",331,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14688.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11750.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11298.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10733.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11298.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14688.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11298.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14688.02,
"RECTAL RESECTION WITH MCC",332,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29977.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23982.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23059.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21906.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23059.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29977.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23059.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29977.57,
"RECTAL RESECTION WITH CC",333,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19890,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15912,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15300,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14535,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15300,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19890,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15300,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19890,
"RECTAL RESECTION WITHOUT CC/MCC",334,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14332.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11466.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11025.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10474.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11025.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14332.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11025.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14332.96,
"PERITONEAL ADHESIOLYSIS WITH MCC",335,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29584.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23667.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22757.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21619.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22757.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29584.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22757.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29584.65,
"PERITONEAL ADHESIOLYSIS WITH CC",336,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18047.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14438.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13882.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13188.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13882.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18047.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13882.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18047.65,
"PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC",337,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13521.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10816.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10400.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9880.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10400.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13521.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10400.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13521.05,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC",344,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21788.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17430.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16760.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15922.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16760.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21788.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16760.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21788.38,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC",345,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13281.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10625.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10216.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9706.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10216.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13281.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10216.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13281.98,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC",346,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10768.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8615.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8283.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7869.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8283.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10768.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8283.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10768.97,
"ANAL AND STOMAL PROCEDURES WITH MCC",347,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19522.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15617.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15017.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14266.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15017.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19522.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15017.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19522.31,
"ANAL AND STOMAL PROCEDURES WITH CC",348,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11736.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9389.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9027.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8576.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9027.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11736.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9027.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11736.3,
"ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC",349,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8278.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6623.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6368.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6049.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6368.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8278.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6368.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8278.83,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC",350,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21071.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16856.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16208.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15398.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16208.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21071.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16208.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21071.15,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC",351,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13438.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10750.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10337.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9820.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10337.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13438.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10337.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13438.22,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC",352,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10623.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8499.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8172.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7763.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8172.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10623.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8172.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10623.8,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC",353,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24306.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19445.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18697.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17762.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18697.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24306.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18697.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24306.92,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC",354,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14684.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11747.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11295.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10730.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11295.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14684.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11295.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14684.07,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC",355,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12021.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9617.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9247.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8785.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9247.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12021.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9247.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12021.92,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC",356,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36069.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28855.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27745.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26358.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",27745.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36069.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",27745.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,36069.57,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC",357,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19758.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15806.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15198.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14438.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15198.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19758.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15198.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19758.23,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",358,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12439.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9951.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9568.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9090.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9568.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12439.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9568.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12439.31,
"PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC",359,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28540.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22832.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21954.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20856.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21954.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28540.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21954.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28540.77,
"PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC",360,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20458.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16367.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15737.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14950.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15737.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20458.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15737.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20458.88,
"MAJOR ESOPHAGEAL DISORDERS WITH MCC",368,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13970.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11176.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10746.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10208.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10746.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13970.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10746.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13970.01,
"MAJOR ESOPHAGEAL DISORDERS WITH CC",369,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9301.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7441.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7154.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6797.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7154.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9301.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7154.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9301.4,
"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC",370,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6939.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5551.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5337.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5070.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5337.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6939.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5337.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6939.09,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC",371,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15399.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12319.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11845.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11253.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11845.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15399.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11845.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15399.71,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC",372,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9465.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7572.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7281.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6917.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7281.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9465.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7281.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9465.52,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC",373,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7148.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5719.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5499.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5224.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5499.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7148.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5499.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7148.96,
"DIGESTIVE MALIGNANCY WITH MCC",374,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18284.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14627.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14064.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13361.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14064.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18284.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14064.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18284.36,
"DIGESTIVE MALIGNANCY WITH CC",375,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10953.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8762.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8425.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8004.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8425.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10953.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8425.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10953.59,
"DIGESTIVE MALIGNANCY WITHOUT CC/MCC",376,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8702.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6962.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6694.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6359.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6694.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8702.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6694.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8702.54,
"GASTROINTESTINAL HEMORRHAGE WITH MCC",377,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15832.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12666.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12179.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11570.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12179.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15832.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12179.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15832.87,
"GASTROINTESTINAL HEMORRHAGE WITH CC",378,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9147.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7318.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7036.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6684.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7036.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9147.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7036.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9147.54,
"GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC",379,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6383.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5106.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4910.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4664.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4910.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6383.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4910.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6383.61,
"COMPLICATED PEPTIC ULCER WITH MCC",380,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16891.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13513.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12993.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12343.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12993.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16891.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12993.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16891.73,
"COMPLICATED PEPTIC ULCER WITH CC",381,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9958.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7966.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7660.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7277.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7660.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9958.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7660.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9958.65,
"COMPLICATED PEPTIC ULCER WITHOUT CC/MCC",382,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7726.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6181.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5943.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5646.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5943.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7726.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5943.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7726.52,
"UNCOMPLICATED PEPTIC ULCER WITH MCC",383,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12303.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9842.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9464.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8991.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9464.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12303.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9464.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12303.6,
"UNCOMPLICATED PEPTIC ULCER WITHOUT MCC",384,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8154.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6523.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6272.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5958.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6272.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8154.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6272.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8154.17,
"INFLAMMATORY BOWEL DISEASE WITH MCC",385,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13894.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11115.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10687.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10153.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10687.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13894.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10687.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13894.27,
"INFLAMMATORY BOWEL DISEASE WITH CC",386,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9112.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7290.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7009.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6659.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7009.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9112.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7009.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9112.82,
"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC",387,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6785.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5428.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5219.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4958.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5219.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6785.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5219.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6785.22,
"GASTROINTESTINAL OBSTRUCTION WITH MCC",388,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13061.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10449.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10047.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9545.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10047.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13061.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10047.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13061.85,
"GASTROINTESTINAL OBSTRUCTION WITH CC",389,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7641.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6113.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5877.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5584.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5877.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7641.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5877.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7641.31,
"GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC",390,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5701.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4561.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4386.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4166.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4386.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5701.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4386.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5701.9,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11416.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9133.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8782.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8343,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8782.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11416.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8782.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11416.74,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7560.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6048.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5816.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5525.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5816.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7560.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5816.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7560.84,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC",393,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14028.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11222.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10791.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10251.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10791.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14028.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10791.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14028.39,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC",394,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8792.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7033.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6763.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6425.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6763.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8792.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6763.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8792.49,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC",395,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6530.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5224.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5023.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4772.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5023.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6530.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5023.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6530.37,
"APPENDIX PROCEDURES WITH MCC",397,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20305.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16244.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15619.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14838.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15619.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20305.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15619.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20305.81,
"APPENDIX PROCEDURES WITH CC",398,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13352.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10681.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10270.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9757.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10270.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13352.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10270.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13352.21,
"APPENDIX PROCEDURES WITHOUT CC/MCC",399,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10441.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8353.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8031.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7630.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8031.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10441.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8031.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10441.52,
"SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL",402,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33132.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26505.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25486.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24211.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",25486.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33132.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",25486.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,33132.06,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44572.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35658.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34286.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32572.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34286.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44572.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34286.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,44572.8,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24292.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19434.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18686.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17752.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18686.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24292.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18686.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24292.71,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18922.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15138.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14555.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13828.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14555.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18922.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14555.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18922.67,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC",408,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29542.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23634.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22725.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21588.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22725.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29542.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22725.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29542.83,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC",409,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18588.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14871.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14299.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13584.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14299.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18588.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14299.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18588.91,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC",410,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13936.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11149.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10720.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10184.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10720.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13936.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10720.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13936.87,
"CHOLECYSTECTOMY WITH C.D.E. WITH MCC",411,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27473.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21978.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21133.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20076.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21133.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27473.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21133.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,27473.24,
"CHOLECYSTECTOMY WITH C.D.E. WITH CC",412,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17998.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14398.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13845.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13152.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13845.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17998.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13845.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17998.73,
"CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC",413,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14511.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11609.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11162.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10604.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11162.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14511.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11162.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14511.28,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC",414,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29519.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23615.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22707.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21571.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22707.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29519.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22707.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29519.15,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC",415,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17716.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14173.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13627.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12946.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13627.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17716.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13627.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17716.27,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC",416,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12166.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9733.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9358.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8890.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9358.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12166.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9358.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12166.31,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC",417,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20238.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16190.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15568.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14789.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15568.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20238.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15568.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20238.74,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC",418,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14756.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11805.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11351.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10783.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11351.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14756.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11351.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14756.66,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC",419,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12186.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9748.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9373.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8905.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9373.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12186.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9373.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12186.04,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC",420,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28292.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22633.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21763.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20675.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21763.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28292.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21763.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28292.24,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC",421,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15118.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12095.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11629.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11048.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11629.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15118.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11629.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15118.82,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC",422,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12451.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9961.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9578.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9099.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9578.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12451.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9578.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12451.95,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC",423,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34177.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27342.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26290.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24975.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26290.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34177.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26290.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34177.51,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC",424,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18672.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14938.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14363.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13645.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14363.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18672.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14363.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18672.54,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC",425,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13247.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10597.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10190.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9680.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10190.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13247.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10190.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13247.27,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",426,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",88368.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",70695,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",67975.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",64577.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",67975.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",88368.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",67975.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,88368.75,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC",427,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",58365.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46692.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44896.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42651.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",44896.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",58365.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",44896.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,58365.61,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC",428,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",45768.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36614.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35206.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33445.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",35206.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",45768.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",35206.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,45768.16,
"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC",429,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",72496.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",57997.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",55766.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",52978.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",55766.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",72496.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",55766.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,72496.89,
"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC",430,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46913.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37530.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36086.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34282.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",36086.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",46913.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",36086.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,46913.02,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC",432,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16939.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13551.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13030.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12378.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13030.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16939.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13030.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16939.08,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC",433,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9743.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7794.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7494.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7120.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7494.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9743.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7494.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9743.24,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC",434,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7031.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5625.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5408.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5138.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5408.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7031.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5408.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7031.4,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC",435,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15901.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12721.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12231.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11620.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12231.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15901.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12231.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15901.52,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC",436,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10334.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8267.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7949.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7551.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7949.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10334.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7949.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10334.22,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC",437,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8142.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6513.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6263.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5950.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6263.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8142.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6263.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8142.33,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC",438,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14272.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11417.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10978.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10429.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10978.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14272.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10978.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14272.21,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC",439,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8046.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6437.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6189.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5880.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6189.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8046.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6189.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8046.86,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC",440,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6312.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5050.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4855.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4613.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4855.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6312.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4855.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6312.61,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15570.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12456.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11977.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11378.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11977.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15570.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11977.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15570.14,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9026.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7220.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6943.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6595.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6943.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9026.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6943.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9026.03,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6930.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5544.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5331.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5064.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5331.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6930.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5331.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6930.4,
"DISORDERS OF THE BILIARY TRACT WITH MCC",444,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14593.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11674.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11225.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10664.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11225.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14593.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11225.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14593.33,
"DISORDERS OF THE BILIARY TRACT WITH CC",445,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10044.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8035.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7726.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7340.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7726.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10044.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7726.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10044.66,
"DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC",446,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7937.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6349.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6105.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5800.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6105.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7937.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6105.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7937.19,
"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",447,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",54128.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43302.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",41637.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39555.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",41637.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",54128.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",41637.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,54128.58,
"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC",448,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34870.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27896.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26823.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25482.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26823.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34870.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26823.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34870.26,
"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",450,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43461.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34768.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33431.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31760.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",33431.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",43461.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",33431.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,43461.08,
"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC",451,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26898.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21518.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20690.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19656.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20690.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26898.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20690.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26898.04,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",67713.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",54171.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",52087.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",49483.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",52087.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",67713.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",52087.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,67713.87,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",48459.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38767.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37276.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35412.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",37276.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48459.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",37276.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,48459.5,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34332.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27465.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26409.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25088.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26409.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34332.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26409.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34332.16,
"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC",461,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44987.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35989.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34605.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32875.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34605.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44987.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34605.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,44987.03,
"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC",462,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22397.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17918,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17228.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16367.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17228.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22397.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17228.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22397.51,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC",463,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46379.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37103.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35676.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33892.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",35676.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",46379.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",35676.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,46379.66,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC",464,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25985.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20788.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19988.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18989.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19988.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25985.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19988.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25985.15,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",465,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15798.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12639.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12153.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11545.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12153.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15798.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12153.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15798.95,
"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC",466,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",42481.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33984.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32677.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31043.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",32677.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42481.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",32677.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,42481.13,
"REVISION OF HIP OR KNEE REPLACEMENT WITH CC",467,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29235.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23388.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22488.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21364.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22488.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29235.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22488.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29235.12,
"REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC",468,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23091.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18473.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17762.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16874.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17762.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23091.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17762.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23091.84,
"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT",469,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25342.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20273.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19493.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18519.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19493.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25342.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19493.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25342.11,
"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC",470,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16628.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13303.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12791.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12151.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12791.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16628.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12791.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16628.99,
"CERVICAL SPINAL FUSION WITH MCC",471,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39508.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31607.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30391.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28871.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",30391.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39508.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",30391.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,39508.9,
"CERVICAL SPINAL FUSION WITH CC",472,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24654.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19723.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18965.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18017.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18965.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24654.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18965.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24654.86,
"CERVICAL SPINAL FUSION WITHOUT CC/MCC",473,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20671.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16537.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15901.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15106.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15901.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20671.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15901.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20671.91,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC",474,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35281.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28225.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27139.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25782.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",27139.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35281.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",27139.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,35281.35,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC",475,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19365.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15492.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14896.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14151.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14896.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19365.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14896.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19365.31,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",476,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10721.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8577.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8247.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7835.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8247.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10721.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8247.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10721.63,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",477,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28667.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22933.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22051.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20948.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22051.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28667.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22051.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28667.02,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",478,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20813.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16650.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16010.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15209.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16010.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20813.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16010.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20813.14,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",479,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16076.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12861.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12366.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11748.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12366.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16076.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12366.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16076.68,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC",480,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24388.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19510.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18760.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17822.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18760.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24388.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18760.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24388.18,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC",481,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17935.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14348.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13796.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13106.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13796.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17935.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13796.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17935.61,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC",482,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14278.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11422.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10983.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10434.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10983.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14278.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10983.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14278.52,
"MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES",483,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23280.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18624.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17908,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17012.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17908,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23280.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17908,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23280.4,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC",485,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26872,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21497.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20670.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19637.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20670.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26872,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20670.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26872,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC",486,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17908.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14327.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13775.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13087.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13775.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17908.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13775.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17908.77,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC",487,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13767.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11013.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10590.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10060.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10590.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13767.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10590.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13767.23,
"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC",488,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15366.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12293.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11820.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11229.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11820.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15366.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11820.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15366.57,
"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC",489,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10221.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8177.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7862.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7469.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7862.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10221.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7862.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10221.39,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30379.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24303.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23368.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22200.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23368.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30379.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23368.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30379.19,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21419.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17135.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16476.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15653.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16476.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21419.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16476.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21419.91,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17241.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13793.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13262.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12599.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13262.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17241.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13262.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17241.26,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC",495,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30017.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24013.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23090.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21935.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23090.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30017.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23090.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30017.03,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC",496,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15642.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12514.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12032.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11431.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12032.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15642.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12032.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15642.73,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC",497,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10943.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8754.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8417.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7997.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8417.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10943.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8417.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10943.35,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC",498,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25212.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20170.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19394.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18424.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19394.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25212.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19394.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25212.71,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC",499,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17306.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13845.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13312.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12647.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13312.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17306.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13312.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17306.77,
"SOFT TISSUE PROCEDURES WITH MCC",500,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26380.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21104.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20292.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19278.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20292.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26380.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20292.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26380.46,
"SOFT TISSUE PROCEDURES WITH CC",501,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15202.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12161.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11694.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11109.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11694.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15202.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11694.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15202.46,
"SOFT TISSUE PROCEDURES WITHOUT CC/MCC",502,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12029.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9623.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9253.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8790.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9253.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12029.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9253.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12029.03,
"FOOT PROCEDURES WITH MCC",503,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23431.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18745.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18024.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17123.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18024.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23431.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18024.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23431.89,
"FOOT PROCEDURES WITH CC",504,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16157.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12926.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12429.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11807.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12429.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16157.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12429.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16157.95,
"FOOT PROCEDURES WITHOUT CC/MCC",505,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15555.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12444.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11965.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11367.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11965.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15555.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11965.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15555.14,
"MAJOR THUMB OR JOINT PROCEDURES",506,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12055.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9644.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9273.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8809.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9273.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12055.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9273.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12055.06,
"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC",507,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15662.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12529.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12048.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11445.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12048.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15662.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12048.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15662.45,
"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC",508,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13358.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10686.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10275.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9761.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10275.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13358.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10275.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13358.51,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25241.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20193.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19416.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18446.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19416.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25241.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19416.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25241.91,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17816.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14253.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13704.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13019.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13704.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17816.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13704.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17816.47,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14471.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11576.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11131.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10574.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11131.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14471.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11131.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14471.03,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13831.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11064.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10639.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10107.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10639.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13831.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10639.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13831.14,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9475.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7580.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7289.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6924.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7289.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9475.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7289.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9475.77,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC",515,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26554.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21243.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20426.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19405.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20426.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26554.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20426.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26554.83,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC",516,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17806.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14244.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13697.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13012.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13697.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17806.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13697.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17806.2,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC",517,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13534.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10827.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10411.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9890.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10411.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13534.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10411.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13534.47,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR",518,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30897.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24718.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23767.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22578.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23767.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30897.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23767.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30897.57,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC",519,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17191.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13753.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13224.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12563.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13224.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17191.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13224.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17191.56,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC",520,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13196.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10557.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10151.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9643.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10151.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13196.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10151.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13196.77,
"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC",521,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24056.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19244.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18504.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17579.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18504.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24056.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18504.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24056.01,
"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC",522,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18118.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14494.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13937.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13240.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13937.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18118.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13937.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18118.65,
"FRACTURES OF FEMUR WITH MCC",533,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13779.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11023.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10599.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10069.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10599.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13779.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10599.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13779.06,
"FRACTURES OF FEMUR WITHOUT MCC",534,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7769.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6215.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5976.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5678.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5976.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7769.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5976.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7769.91,
"FRACTURES OF HIP AND PELVIS WITH MCC",535,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11524.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9219.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8865.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8422.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8865.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11524.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8865.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11524.85,
"FRACTURES OF HIP AND PELVIS WITHOUT MCC",536,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7781.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6225.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5985.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5686.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5985.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7781.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5985.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7781.76,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8939.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7151.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6876.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6532.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6876.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8939.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6876.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8939.24,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7092.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5674.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5456.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5183.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5456.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7092.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5456.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7092.94,
"OSTEOMYELITIS WITH MCC",539,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16950.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13560.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13039.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12387.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13039.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16950.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13039.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16950.92,
"OSTEOMYELITIS WITH CC",540,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11637.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9310.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8952.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8504.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8952.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11637.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8952.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11637.68,
"OSTEOMYELITIS WITHOUT CC/MCC",541,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7622.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6097.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5863.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5570.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5863.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7622.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5863.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7622.37,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC",542,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15347.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12278.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11805.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11215.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11805.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15347.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11805.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15347.63,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC",543,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9520.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7616.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7323.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6957.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7323.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9520.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7323.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9520.75,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC",544,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7363.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5890.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5664.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5381.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5664.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7363.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5664.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7363.58,
"CONNECTIVE TISSUE DISORDERS WITH MCC",545,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20990.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16792.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16146.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15339.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16146.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20990.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16146.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20990.67,
"CONNECTIVE TISSUE DISORDERS WITH CC",546,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10510.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8408.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8084.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7680.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8084.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10510.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8084.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10510.18,
"CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",547,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8007.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6405.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6159.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5851.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6159.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8007.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6159.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8007.4,
"SEPTIC ARTHRITIS WITH MCC",548,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16644.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13315.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12803.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12163.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12803.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16644.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12803.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16644.77,
"SEPTIC ARTHRITIS WITH CC",549,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10934.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8747.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8411.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7990.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8411.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10934.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8411.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10934.66,
"SEPTIC ARTHRITIS WITHOUT CC/MCC",550,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8306.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6645.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6389.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6070.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6389.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8306.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6389.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8306.45,
"MEDICAL BACK PROBLEMS WITH MCC",551,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14634.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11707.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11257.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10694.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11257.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14634.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11257.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14634.36,
"MEDICAL BACK PROBLEMS WITHOUT MCC",552,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8994.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7195.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6918.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6572.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6918.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8994.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6918.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8994.48,
"BONE DISEASES AND ARTHROPATHIES WITH MCC",553,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11637.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9310.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8952.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8504.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8952.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11637.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8952.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11637.68,
"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC",554,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7959.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6367.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6122.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5816.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6122.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7959.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6122.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7959.29,
"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",555,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11838.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9471.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9106.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8651.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9106.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11838.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9106.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11838.88,
"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC",556,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7963.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6370.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6125.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5819.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6125.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7963.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6125.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7963.22,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13141.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10513.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10108.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9603.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10108.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13141.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10108.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13141.54,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8457.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6765.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6505.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6180.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6505.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8457.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6505.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8457.15,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16124.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12899.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12403.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11782.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12403.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16124.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12403.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16124.02,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10294.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8235.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7919.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7523.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7919.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10294.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7919.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10294.77,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7752.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6202.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5963.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5665.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5963.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7752.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5963.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7752.56,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12651.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10121.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9731.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9245.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9731.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12651.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9731.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12651.56,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8475.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6780.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6519.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6193.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6519.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8475.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6519.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8475.29,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC",564,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13588.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10871.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10453.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9930.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10453.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13588.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10453.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13588.91,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC",565,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9097.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7278.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6998.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6648.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6998.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9097.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6998.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9097.83,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC",566,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7321.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5857.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5632.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5350.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5632.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7321.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5632.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7321.76,
"SKIN DEBRIDEMENT WITH MCC",570,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24615.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19692.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18934.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17988.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18934.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24615.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18934.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24615.41,
"SKIN DEBRIDEMENT WITH CC",571,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14740.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11792.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11338.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10771.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11338.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14740.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11338.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14740.09,
"SKIN DEBRIDEMENT WITHOUT CC/MCC",572,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10454.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8363.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8041.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7639.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8041.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10454.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8041.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10454.16,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC",573,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",53101.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",42481.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40847.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38804.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",40847.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",53101.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",40847.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,53101.28,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC",574,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28799.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23039.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22153.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21045.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22153.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28799.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22153.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28799.58,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC",575,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15588.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12470.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11990.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11391.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11990.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15588.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11990.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15588.27,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC",576,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40080.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32064.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30831.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29289.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",30831.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40080.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",30831.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,40080.94,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC",577,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22324.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17859.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17172.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16313.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17172.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22324.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17172.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22324.12,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC",578,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14084.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11267.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10834.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10292.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10834.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14084.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10834.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14084.41,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26961.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21569.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20739.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19702.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20739.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26961.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20739.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26961.96,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15043.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12035.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11572.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10993.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11572.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15043.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11572.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15043.86,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12795.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10236.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9843.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9350.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9843.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12795.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9843.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12795.95,
"MASTECTOMY FOR MALIGNANCY WITH CC/MCC",582,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16610.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13288.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12777.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12138.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12777.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16610.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12777.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16610.85,
"MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC",583,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15015.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12012.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11550.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10972.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11550.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15015.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11550.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15015.46,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18300.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14640.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14077.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13373.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14077.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18300.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14077.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18300.13,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16630.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13304.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12792.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12153.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12792.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16630.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12792.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16630.58,
"SKIN ULCERS WITH MCC",592,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16679.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13343.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12830.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12188.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12830.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16679.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12830.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16679.49,
"SKIN ULCERS WITH CC",593,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10769.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8615.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8284.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7870.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8284.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10769.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8284.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10769.76,
"SKIN ULCERS WITHOUT CC/MCC",594,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8248.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6599.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6345.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6028.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6345.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8248.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6345.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8248.85,
"MAJOR SKIN DISORDERS WITH MCC",595,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18142.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14513.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13955.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13257.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13955.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18142.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13955.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18142.33,
"MAJOR SKIN DISORDERS WITHOUT MCC",596,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9950.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7960.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7654.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7271.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7654.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9950.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7654.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9950.76,
"MALIGNANT BREAST DISORDERS WITH MCC",597,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14563.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11650.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11202.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10642.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11202.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14563.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11202.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14563.35,
"MALIGNANT BREAST DISORDERS WITH CC",598,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10335.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8268.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7950.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7553.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7950.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10335.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7950.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10335.81,
"MALIGNANT BREAST DISORDERS WITHOUT CC/MCC",599,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7480.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5984.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5754.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5466.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5754.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7480.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5754.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7480.34,
"NON-MALIGNANT BREAST DISORDERS WITH CC/MCC",600,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9628.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7702.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7406.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7035.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7406.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9628.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7406.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9628.06,
"NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC",601,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6183.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4946.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4756.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4518.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4756.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6183.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4756.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6183.2,
"CELLULITIS WITH MCC",602,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12623.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10099.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9710.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9225.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9710.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12623.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9710.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12623.95,
"CELLULITIS WITHOUT MCC",603,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8281.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6624.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6370.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6051.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6370.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8281.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6370.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8281.2,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13024.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10419.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10019.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9518.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10019.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13024.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10019.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13024.77,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8637.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6909.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6643.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6311.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6643.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8637.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6643.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8637.04,
"MINOR SKIN DISORDERS WITH MCC",606,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13349.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10679.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10268.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9755.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10268.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13349.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10268.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13349.05,
"MINOR SKIN DISORDERS WITHOUT MCC",607,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8561.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6849.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6585.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6256.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6585.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8561.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6585.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8561.29,
"ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC",614,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18703.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14962.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14387.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13667.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14387.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18703.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14387.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18703.32,
"ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC",615,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12450.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9960.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9577.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9098.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9577.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12450.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9577.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12450.36,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28925.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23140.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22250.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21138.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22250.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28925.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22250.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28925.82,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16166.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12933.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12435.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11814.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12435.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16166.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12435.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16166.63,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12600.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10080.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9692.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9207.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9692.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12600.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9692.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12600.28,
"O.R. PROCEDURES FOR OBESITY WITH MCC",619,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24191.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19353.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18609.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17678.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18609.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24191.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18609.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24191.71,
"O.R. PROCEDURES FOR OBESITY WITH CC",620,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14036.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11229.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10797.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10257.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10797.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14036.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10797.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14036.3,
"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC",621,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13311.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10648.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10239.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9727.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10239.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13311.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10239.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13311.18,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29492.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23593.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22686.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21552.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22686.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29492.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22686.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29492.33,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15563.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12451.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11972.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11373.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11972.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15563.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11972.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15563.82,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11287.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9029.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8682.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8248.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8682.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11287.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8682.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11287.35,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25238.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20190.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19414.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18443.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19414.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25238.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19414.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25238.73,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13240.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10592.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10184.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9675.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10184.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13240.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10184.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13240.18,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11890.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9512.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9146.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8688.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9146.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11890.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9146.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11890.16,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30814.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24651.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23703.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22518.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23703.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30814.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23703.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30814.72,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18600.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14880.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14308.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13592.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14308.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18600.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14308.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18600.74,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12925.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10340.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9942.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9445.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9942.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12925.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9942.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12925.34,
"DIABETES WITH MCC",637,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12745.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10196.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9804.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9313.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9804.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12745.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9804.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12745.46,
"DIABETES WITH CC",638,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8480.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6784.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6523.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6197.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6523.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8480.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6523.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8480.82,
"DIABETES WITHOUT CC/MCC",639,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6311.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5048.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4854.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4611.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4854.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6311.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4854.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6311.03,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11947.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9558.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9190.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8731.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9190.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11947.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9190.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11947.75,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7549.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6039.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5807.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5517.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5807.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7549.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5807.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7549.79,
"INBORN AND OTHER DISORDERS OF METABOLISM",642,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12630.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10104.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9715.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9229.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9715.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12630.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9715.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12630.27,
"ENDOCRINE DISORDERS WITH MCC",643,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14397.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11518.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11075.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10521.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11075.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14397.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11075.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14397.66,
"ENDOCRINE DISORDERS WITH CC",644,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9497.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7597.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7305.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6940.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7305.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9497.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7305.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9497.07,
"ENDOCRINE DISORDERS WITHOUT CC/MCC",645,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7471.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5977.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5747.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5460.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5747.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7471.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5747.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7471.66,
"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC",650,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38504.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30803.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29618.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28137.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",29618.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38504.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",29618.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,38504.47,
"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC",651,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30649.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24519.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23576.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22397.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23576.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30649.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23576.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30649.03,
"KIDNEY TRANSPLANT",652,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26890.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21512.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20685.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19651.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20685.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26890.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20685.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26890.94,
"MAJOR BLADDER PROCEDURES WITH MCC",653,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",42410.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33928.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32623.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30992,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",32623.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42410.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",32623.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,42410.11,
"MAJOR BLADDER PROCEDURES WITH CC",654,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23496.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18797.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18074.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17170.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18074.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23496.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18074.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23496.59,
"MAJOR BLADDER PROCEDURES WITHOUT CC/MCC",655,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18109.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14487.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13930.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13234.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13930.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18109.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13930.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18109.99,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC",656,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26530.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21224.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20407.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19387.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20407.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26530.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20407.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26530.36,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC",657,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15848.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12678.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12191.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11581.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12191.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15848.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12191.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15848.65,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC",658,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13653.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10922.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10502.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9977.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10502.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13653.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10502.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13653.61,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC",659,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21457.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17166.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16505.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15680.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16505.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21457.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16505.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21457.77,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC",660,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11838.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9470.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9106.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8650.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9106.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11838.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9106.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11838.09,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC",661,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9579.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7663.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7368.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7000.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7368.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9579.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7368.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9579.14,
"MINOR BLADDER PROCEDURES WITH MCC",662,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25565.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20452.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19665.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18682.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",19665.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25565.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",19665.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,25565.4,
"MINOR BLADDER PROCEDURES WITH CC",663,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13404.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10723.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10310.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9795.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10310.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13404.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10310.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13404.29,
"MINOR BLADDER PROCEDURES WITHOUT CC/MCC",664,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9669.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7735.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7438.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7066.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7438.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9669.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7438.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9669.87,
"PROSTATECTOMY WITH MCC",665,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26036.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20829.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20028.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19026.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20028.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26036.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20028.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26036.44,
"PROSTATECTOMY WITH CC",666,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15211.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12169.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11701.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11116.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11701.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15211.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11701.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15211.92,
"PROSTATECTOMY WITHOUT CC/MCC",667,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10137.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8110.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7798.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7408.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7798.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10137.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7798.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10137.76,
"TRANSURETHRAL PROCEDURES WITH MCC",668,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24448.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19559.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18806.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17866.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18806.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24448.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18806.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24448.94,
"TRANSURETHRAL PROCEDURES WITH CC",669,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13655.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10924.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10503.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9978.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10503.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13655.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10503.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13655.19,
"TRANSURETHRAL PROCEDURES WITHOUT CC/MCC",670,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9120.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7296.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7015.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6665.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7015.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9120.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7015.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9120.72,
"URETHRAL PROCEDURES WITH CC/MCC",671,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15572.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12458,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11978.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11379.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11978.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15572.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11978.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15572.51,
"URETHRAL PROCEDURES WITHOUT CC/MCC",672,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9927.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7941.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7636.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7254.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7636.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9927.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7636.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9927.09,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC",673,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34560.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27648.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26585.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25256.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26585.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34560.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26585.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34560.97,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC",674,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19861.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15889.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15278.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14514.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15278.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19861.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15278.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19861.6,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC",675,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14360.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11488.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11046.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10494.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11046.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14360.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11046.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14360.58,
"RENAL FAILURE WITH MCC",682,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13094.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10475.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10073.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9569.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10073.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13094.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10073.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13094.99,
"RENAL FAILURE WITH CC",683,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8319.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6655.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6399.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6079.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6399.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8319.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6399.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8319.87,
"RENAL FAILURE WITHOUT CC/MCC",684,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6146.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4916.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4727.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4491.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4727.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6146.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4727.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6146.13,
"KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC",686,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15641.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12512.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12031.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11430.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12031.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15641.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12031.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15641.15,
"KIDNEY AND URINARY TRACT NEOPLASMS WITH CC",687,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9676.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7741.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7443.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7071.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7443.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9676.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7443.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9676.98,
"KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC",688,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7645.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6116.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5880.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5586.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5880.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7645.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5880.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7645.25,
"KIDNEY AND URINARY TRACT INFECTIONS WITH MCC",689,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10564.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8451.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8126.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7720.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8126.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10564.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8126.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10564.61,
"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC",690,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7796.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6237.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5997.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5697.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5997.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7796.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5997.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7796.75,
"URINARY STONES WITH MCC",693,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12017.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9614.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9244.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8782.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9244.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12017.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9244.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12017.98,
"URINARY STONES WITHOUT MCC",694,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7577.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6061.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5828.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5537.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5828.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7577.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5828.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7577.4,
"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC",695,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10434.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8347.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8026.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7625.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8026.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10434.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8026.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10434.42,
"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC",696,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6845.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5476.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5266.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5002.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5266.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6845.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5266.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6845.98,
"URETHRAL STRICTURE",697,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9913.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7930.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7625.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7244.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7625.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9913.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7625.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9913.67,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC",698,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14463.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11570.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11125.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10569.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11125.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14463.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11125.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14463.15,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC",699,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9418.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7534.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7244.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6882.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7244.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9418.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7244.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9418.18,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC",700,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6853.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5482.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5271.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5008.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5271.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6853.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5271.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6853.08,
"MAJOR MALE PELVIC PROCEDURES WITH CC/MCC",707,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17192.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13753.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13224.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12563.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13224.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17192.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13224.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17192.34,
"MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC",708,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13514.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10811.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10395.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9876.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10395.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13514.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10395.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13514.74,
"PENIS PROCEDURES WITH CC/MCC",709,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19770.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15816.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15208.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14447.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15208.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19770.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15208.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19770.86,
"PENIS PROCEDURES WITHOUT CC/MCC",710,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12465.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9972.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9588.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9109.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9588.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12465.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9588.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12465.36,
"TESTES PROCEDURES WITH CC/MCC",711,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17851.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14280.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13731.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13045.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13731.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17851.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13731.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17851.17,
"TESTES PROCEDURES WITHOUT CC/MCC",712,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10086.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8069.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7758.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7370.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7758.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10086.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7758.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10086.48,
"TRANSURETHRAL PROSTATECTOMY WITH CC/MCC",713,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13271.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10617.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10209.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9698.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10209.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13271.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10209.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13271.73,
"TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC",714,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9752.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7802.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7502.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7126.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7502.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9752.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7502.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9752.72,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC",715,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19062.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15249.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14663.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13930.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14663.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19062.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14663.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19062.33,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC",716,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13016.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10412.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10012.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9511.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10012.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13016.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10012.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13016.08,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC",717,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16326.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13060.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11930.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16326.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16326.01,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC",718,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12006.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9605.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9236.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8774.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9236.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12006.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9236.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12006.94,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15688.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12550.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12068.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11464.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12068.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15688.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12068.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15688.48,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10425.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8340.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8019.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7618.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8019.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10425.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8019.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10425.74,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6583.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5266.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5064.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4810.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5064.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6583.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5064.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6583.24,
"BENIGN PROSTATIC HYPERTROPHY WITH MCC",725,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10642.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8514.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8186.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7777.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8186.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10642.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8186.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10642.74,
"BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC",726,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7106.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5685.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5466.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5193.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5466.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7106.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5466.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7106.35,
"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC",727,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13109.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10487.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10084.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9580.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10084.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13109.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10084.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13109.98,
"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC",728,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7810.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6248.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6007.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5707.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6007.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7810.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6007.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7810.17,
"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC",729,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9762.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7810.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7509.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7134.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7509.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9762.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7509.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9762.97,
"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC",730,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6711.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5369.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5162.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4904.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5162.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6711.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5162.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6711.85,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18215.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14572.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14012.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13311.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14012.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18215.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14012.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18215.7,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12025.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9620.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9250.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8788.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9250.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12025.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9250.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12025.87,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC",736,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29613.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23690.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22779.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21640.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22779.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29613.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22779.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29613.05,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC",737,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17668.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14134.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13590.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12911.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13590.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17668.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13590.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17668.13,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC",738,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12996.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10397.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9997.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9497.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9997.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12996.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9997.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12996.36,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC",739,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29678.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23742.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22829.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21688.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",22829.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29678.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",22829.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,29678.55,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC",740,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15687.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12550.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12067.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11464.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12067.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15687.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12067.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15687.7,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC",741,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12661.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10129.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9739.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9252.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9739.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12661.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9739.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12661.82,
"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC",742,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15886.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12709.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12220.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11609.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12220.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15886.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12220.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15886.52,
"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC",743,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11198.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8959.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8614.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8183.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8614.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11198.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8614.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11198.99,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17577.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14061.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13521.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12845.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13521.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17577.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13521.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17577.39,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10384.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8307.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7988.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7588.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7988.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10384.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7988.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10384.73,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15115.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12092.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11627.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11046.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11627.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15115.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11627.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15115.66,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8192.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6554.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6302.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5987.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6302.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8192.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6302.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8192.83,
"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES",748,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12355.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9884.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9504.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9029.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9504.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12355.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9504.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12355.68,
"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC",749,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21668.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17334.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16668.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15834.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16668.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21668.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16668.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21668.44,
"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",750,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13053.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10443.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10041.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9539.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10041.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13053.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10041.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13053.96,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15940.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12752.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12262.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11649.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12262.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15940.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12262.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15940.98,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9992.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7994.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7686.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7302.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7686.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9992.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7686.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9992.57,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8988.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7190.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6913.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6568.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6913.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8988.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6913.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8988.16,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12707.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10166.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9775.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9286.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9775.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12707.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9775.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12707.59,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9134.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7307.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7026.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6674.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7026.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9134.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7026.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9134.14,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6645.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5316.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5111.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4856.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5111.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6645.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5111.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6645.56,
"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC",760,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9359,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7487.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7199.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6839.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7199.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9359,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7199.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9359,
"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC",761,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5911,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4728.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4546.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4319.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4546.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5911,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4546.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5911,
"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C",768,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7891.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7588.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7208.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7588.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7588.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7891.8,
"POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES",769,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14742.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11793.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11340.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10773.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11340.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14742.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11340.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14742.46,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9321.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7456.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7170.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6811.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7170.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9321.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7170.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9321.13,
"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES",776,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6575.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5260.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5057.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4805.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5057.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6575.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5057.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6575.35,
"ABORTION WITHOUT D&C",779,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8047.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6438.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6190.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5880.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6190.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8047.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6190.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8047.65,
"CESAREAN SECTION WITH STERILIZATION WITH MCC",783,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5616,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16624.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15985.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15185.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15985.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20780.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15985.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20780.8,
"CESAREAN SECTION WITH STERILIZATION WITH CC",784,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5616,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7819.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7518.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7142.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7518.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9774.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7518.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9774.01,
"CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC",785,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5616,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7173.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6897.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6552.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6897.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8966.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6897.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8966.85,
"CESAREAN SECTION WITHOUT STERILIZATION WITH MCC",786,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5616,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11539.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11095.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10540.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11095.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14424.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11095.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14424.48,
"CESAREAN SECTION WITHOUT STERILIZATION WITH CC",787,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5616,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8177.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7862.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7469.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7862.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10221.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7862.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10221.39,
"CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC",788,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5616,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7179.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6903.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6558.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6903.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8974.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6903.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8974.75,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15629.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12503.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12022.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11421.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12022.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15629.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12022.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15629.32,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",48304.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38643.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37157.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35299.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",37157.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48304.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",37157.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,48304.85,
"PREMATURITY WITH MAJOR PROBLEMS",791,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",33435.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26748.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25719.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24433.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",25719.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33435.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",25719.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,33435.83,
"PREMATURITY WITHOUT MAJOR PROBLEMS",792,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20734.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16587.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15949.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15151.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15949.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20734.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15949.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20734.25,
"FULL TERM NEONATE WITH MAJOR PROBLEMS",793,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34308.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27446.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26391.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25071.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26391.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34308.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26391.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34308.5,
"NEONATE WITH OTHER SIGNIFICANT PROBLEMS",794,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13054.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10443.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10042.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9540.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10042.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13054.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10042.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13054.76,
"NORMAL NEWBORN",795,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2986.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2388.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2297.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2182.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",2297.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2986.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",2297.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,2986.11,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC",796,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8493.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8167.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7758.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8167.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8167.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8493.98,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC",797,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7442.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7156.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6798.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7156.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7156.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7442.38,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC",798,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7169.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6893.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6548.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6893.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6893.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7169.06,
"SPLENIC PROCEDURES WITH MCC",799,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37143.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29714.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28571.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27143.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28571.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37143.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28571.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37143.43,
"SPLENIC PROCEDURES WITH CC",800,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23576.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18861.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18135.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17228.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18135.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23576.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18135.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,23576.28,
"SPLENIC PROCEDURES WITHOUT CC/MCC",801,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16471.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13176.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12670.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12036.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12670.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16471.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12670.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16471.2,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC",802,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32844.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26275.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25265.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24002.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",25265.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32844.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",25265.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,32844.86,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC",803,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16076.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12861.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12366.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11748.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12366.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16076.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12366.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16076.68,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC",804,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12108.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9686.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9314.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8848.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9314.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12108.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9314.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12108.71,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC",805,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7939.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7634.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7252.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7634.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7634.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7939.78,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC",806,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5887.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5660.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5377.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5660.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5660.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5887.08,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC",807,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5383.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5176.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4917.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5176.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2579,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5176.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5383.36,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC",808,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18830.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15064.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14484.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13760.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14484.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18830.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14484.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18830.34,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC",809,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11397.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9118.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8767.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8329.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8767.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11397.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8767.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11397.82,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC",810,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9667.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7734,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7436.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7064.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7436.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9667.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7436.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9667.5,
"RED BLOOD CELL DISORDERS WITH MCC",811,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12489.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9991.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9607.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9127.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9607.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12489.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9607.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12489.82,
"RED BLOOD CELL DISORDERS WITHOUT MCC",812,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8654.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6923.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6657.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6324.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6657.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8654.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6657.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8654.4,
"COAGULATION DISORDERS",813,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13444.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10755.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10341.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9824.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10341.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13444.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10341.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13444.52,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC",814,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18189.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14551.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13992.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13292.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13992.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18189.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13992.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18189.67,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC",815,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9410.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7528.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7238.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6876.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7238.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9410.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7238.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9410.28,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC",816,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6396.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5116.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4920.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4674.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4920.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6396.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4920.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6396.23,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC",817,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19411.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15529.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14932.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14185.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14932.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19411.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14932.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19411.86,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC",818,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10555.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8444.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8119.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7713.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8119.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10555.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8119.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10555.94,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC",819,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8194.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6555.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6303.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5988.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6303.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8194.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6303.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8194.41,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC",820,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",47683.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38147.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",36679.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34845.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",36679.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",47683.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",36679.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,47683.9,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC",821,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19072.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15258.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14671.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13937.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14671.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19072.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14671.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19072.57,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC",822,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10909.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8727.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8391.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7972.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8391.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10909.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8391.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10909.41,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC",823,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37584.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30067.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28911.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27465.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28911.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37584.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28911.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37584.48,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC",824,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19285.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15428.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14835.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14093.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14835.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19285.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14835.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19285.62,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC",825,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12056.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9645.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9274.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8810.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9274.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12056.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9274.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12056.64,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC",826,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38318.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30654.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29475.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28001.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",29475.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38318.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",29475.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,38318.27,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC",827,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19645.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15716.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15111.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14356.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15111.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19645.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15111.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19645.41,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC",828,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14852.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11882.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11425.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10854.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11425.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14852.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11425.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14852.92,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC",829,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26342.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21074.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20263.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19250.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20263.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26342.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20263.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26342.58,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC",830,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13284.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10627.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10218.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9707.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10218.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13284.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10218.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13284.36,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC",831,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10897.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8718.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8382.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7963.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8382.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10897.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8382.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10897.58,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC",832,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7103.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5682.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5464,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5190.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5464,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7103.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5464,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7103.2,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC",833,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5535.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4428.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4258.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4045.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4258.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5535.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4258.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5535.41,
"ACUTE LEUKEMIA WITH MCC",834,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44725.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",35780.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34404.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32684.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",34404.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44725.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",34404.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,44725.88,
"ACUTE LEUKEMIA WITH CC",835,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17866.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14293.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13743.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13056.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13743.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17866.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13743.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17866.95,
"ACUTE LEUKEMIA WITHOUT CC/MCC",836,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11031.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8825.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8485.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8061.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8485.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11031.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8485.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11031.71,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC",837,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39316.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31453.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30243.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28731.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",30243.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39316.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",30243.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,39316.37,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT",838,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17879.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14303.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13753.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13065.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13753.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17879.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13753.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17879.59,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC",839,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12802.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10241.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9847.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9355.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9847.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12802.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9847.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12802.26,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC",840,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26933.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21546.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20718.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19682.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20718.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26933.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20718.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26933.54,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC",841,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14281.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11425.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10985.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10436.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10985.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14281.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10985.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14281.67,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC",842,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9381.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7505.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7216.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6855.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7216.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9381.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7216.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9381.88,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC",843,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17148.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13719.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13191.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12531.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13191.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17148.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13191.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17148.96,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC",844,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11015.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8812.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8473.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8049.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8473.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11015.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8473.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11015.15,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC",845,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8128.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6503.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6253.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5940.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6253.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8128.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6253.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8128.93,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC",846,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21864.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17491.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16819.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15978.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16819.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21864.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16819.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,21864.91,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC",847,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11731.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9385.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9024.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8573.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9024.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11731.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9024.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11731.56,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC",848,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8111.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6489.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6239.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5927.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6239.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8111.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6239.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8111.56,
RADIOTHERAPY,849,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22788.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18230.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17529.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16652.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17529.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22788.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17529.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22788.05,
"ACUTE LEUKEMIA WITH OTHER PROCEDURES",850,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",69734.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",55787.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",53641.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",50959.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",53641.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",69734.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",53641.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,69734.54,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC",853,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",40376.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32300.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31058.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29505.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",31058.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40376.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",31058.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,40376.02,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC",854,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17174.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13739.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13211.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12550.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13211.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17174.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13211.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17174.99,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC",855,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13222.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10578.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10171.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9662.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10171.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13222.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10171.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13222.81,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC",856,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",37299.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29839.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28692.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27257.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",28692.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37299.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",28692.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,37299.65,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC",857,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18306.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14645.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14081.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13377.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14081.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18306.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14081.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18306.44,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC",858,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12399.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9919.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9538.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9061.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9538.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12399.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9538.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12399.87,
"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC",862,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15798.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12639.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12153.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11545.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12153.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15798.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12153.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15798.95,
"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC",863,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9283.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7426.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7140.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6783.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7140.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9283.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7140.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9283.26,
"FEVER AND INFLAMMATORY CONDITIONS",864,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8413.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6731,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6472.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6148.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6472.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8413.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6472.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8413.76,
"VIRAL ILLNESS WITH MCC",865,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13231.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10585.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10178.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9669.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10178.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13231.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10178.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13231.49,
"VIRAL ILLNESS WITHOUT MCC",866,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8270.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6616.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6362.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6044.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6362.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8270.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6362.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8270.95,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC",867,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17925.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14340.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13788.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13099.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13788.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17925.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13788.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17925.35,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC",868,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9545.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7636.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7342.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6975.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7342.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9545.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7342.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9545.2,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC",869,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7167.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5733.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5513.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5237.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5513.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7167.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5513.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7167.11,
"SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS",870,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",55944.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44755.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43034.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40882.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",43034.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",55944.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",43034.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,55944.9,
"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC",871,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16736.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13389.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12874.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12230.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12874.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16736.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12874.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16736.3,
"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC",872,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9483.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7586.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7295.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6930.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7295.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9483.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7295.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9483.67,
"O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS",876,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31904.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25523.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24541.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23314.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",24541.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31904.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",24541.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,31904.35,
"ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION",880,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8985.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7188.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6912.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6566.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6912.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8985.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6912.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8985.8,
"DEPRESSIVE NEUROSES",881,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8833.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7066.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6795,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6455.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6795,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8833.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6795,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8833.5,
"NEUROSES EXCEPT DEPRESSIVE",882,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9882.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7905.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7601.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7221.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7601.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9882.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7601.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9882.12,
"DISORDERS OF PERSONALITY AND IMPULSE CONTROL",883,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16924.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13539.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13018.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12367.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13018.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16924.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13018.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16924.09,
"ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY",884,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14104.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11283.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10849.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10306.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10849.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14104.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10849.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14104.14,
PSYCHOSES,885,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12430.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9944.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9562.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9083.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9562.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12430.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9562.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12430.64,
"BEHAVIORAL AND DEVELOPMENTAL DISORDERS",886,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17784.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14227.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13680.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12996.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13680.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17784.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13680.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17784.12,
"OTHER MENTAL DISORDER DIAGNOSES",887,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9859.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7887.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7584.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7204.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7584.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9859.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7584.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9859.23,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6277.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5021.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4828.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4587.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4828.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6277.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4828.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6277.1,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12578.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10063.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9676.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9192.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9676.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12578.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9676.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,12578.97,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15178.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12143.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11675.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11092.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11675.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15178.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11675.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15178.77,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8375.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6700.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6442.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6120.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6442.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8375.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6442.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8375.08,
"WOUND DEBRIDEMENTS FOR INJURIES WITH MCC",901,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34521.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27617.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26555.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25227.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26555.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34521.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26555.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34521.51,
"WOUND DEBRIDEMENTS FOR INJURIES WITH CC",902,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16515.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13212.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12704.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12068.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12704.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16515.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12704.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16515.38,
"WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC",903,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10637.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8510.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8183.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7773.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8183.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10637.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8183.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10637.99,
"SKIN GRAFTS FOR INJURIES WITH CC/MCC",904,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30391.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24312.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23377.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22208.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23377.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30391.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23377.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30391.02,
"SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC",905,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13113.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10491.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10087.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9583.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10087.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13113.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10087.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13113.92,
"HAND PROCEDURES FOR INJURIES",906,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16908.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13526.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13006.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12356.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13006.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16908.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13006.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,16908.31,
"OTHER O.R. PROCEDURES FOR INJURIES WITH MCC",907,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31702.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25361.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24386.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23167.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",24386.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31702.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",24386.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,31702.36,
"OTHER O.R. PROCEDURES FOR INJURIES WITH CC",908,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17152.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13721.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13193.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12534.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13193.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17152.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13193.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17152.11,
"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC",909,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11767.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9413.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9051.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8599.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",9051.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11767.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",9051.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11767.08,
"TRAUMATIC INJURY WITH MCC",913,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14306.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11445.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11005.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10455.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11005.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14306.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11005.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14306.92,
"TRAUMATIC INJURY WITHOUT MCC",914,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8396.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6717.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6458.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6135.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6458.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8396.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6458.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8396.4,
"ALLERGIC REACTIONS WITH MCC",915,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14677.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11742.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11290.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10726.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11290.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14677.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11290.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14677.75,
"ALLERGIC REACTIONS WITHOUT MCC",916,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6666.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5333.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5128.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4871.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5128.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6666.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5128.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6666.88,
"POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC",917,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13784.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11027.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10603.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10073.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10603.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13784.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10603.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13784.59,
"POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC",918,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8172.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6537.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6286.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5972.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6286.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8172.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6286.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8172.31,
"COMPLICATIONS OF TREATMENT WITH MCC",919,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15854.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12683.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12196.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11586.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",12196.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15854.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",12196.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15854.97,
"COMPLICATIONS OF TREATMENT WITH CC",920,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9317.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7454.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7167.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6809.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7167.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9317.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7167.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9317.97,
"COMPLICATIONS OF TREATMENT WITHOUT CC/MCC",921,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6841.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5472.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5262.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4999.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5262.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6841.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5262.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6841.24,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15212.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",12170.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11702.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11116.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11702.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15212.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11702.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,15212.7,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9439.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7551.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7261.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6898.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",7261.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9439.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",7261.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,9439.48,
"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT",927,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",169868.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",135894.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",130668.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",124134.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",130668.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",169868.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",130668.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,169868.62,
"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC",928,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",58003.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",46402.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",44618.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42387.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",44618.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",58003.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",44618.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,58003.44,
"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC",929,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26822.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21457.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20632.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19600.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",20632.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26822.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",20632.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,26822.3,
"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT",933,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",32135.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",25708.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24719.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23483.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",24719.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32135.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",24719.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,32135.53,
"FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY",934,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18851.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15081.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14501.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13776.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",14501.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18851.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",14501.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,18851.65,
"NON-EXTENSIVE BURNS",935,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17663.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14130.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13587.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12907.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13587.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17663.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13587.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17663.4,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC",939,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30039.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24031.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23107.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21951.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23107.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30039.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23107.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,30039.13,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC",940,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19848.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15878.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",15267.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14504.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",15267.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19848.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",15267.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,19848.18,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC",941,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17408.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13926.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13391.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12721.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",13391.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17408.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",13391.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,17408.53,
"REHABILITATION WITH CC/MCC",945,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13628.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10902.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10483.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9959.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10483.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13628.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10483.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13628.36,
"REHABILITATION WITHOUT CC/MCC",946,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10458.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8366.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8044.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7642.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8044.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10458.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8044.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10458.1,
"SIGNS AND SYMPTOMS WITH MCC",947,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11425.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9140.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8788.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8349.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8788.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11425.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8788.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11425.43,
"SIGNS AND SYMPTOMS WITHOUT MCC",948,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7725.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6180.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5942.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5645.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",5942.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7725.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",5942.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,7725.73,
"AFTERCARE WITH CC/MCC",949,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10796.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8637.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8305.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7889.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8305.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10796.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8305.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10796.59,
"AFTERCARE WITHOUT CC/MCC",950,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6362.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5089.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4894.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4649.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4894.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6362.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4894.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,6362.32,
"OTHER FACTORS INFLUENCING HEALTH STATUS",951,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",5796.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4637.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",4458.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4235.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",4458.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5796.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",4458.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,5796.6,
"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA",955,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",54519.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",43615.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",41937.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39840.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",41937.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",54519.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",41937.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,54519.14,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",31100.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24880.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",23923.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22727.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",23923.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31100.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",23923.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,31100.34,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC",957,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",61531.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",49225.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",47332.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",44965.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",47332.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",61531.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",47332.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,61531.93,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC",958,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",34658.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",27726.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",26660.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25327.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",26660.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34658.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",26660.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,34658.03,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC",959,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24639.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19711.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18953.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18005.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18953.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24639.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18953.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24639.1,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC",963,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22979.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18383.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17676.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16792.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17676.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22979.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17676.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22979.79,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC",964,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",13502.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10801.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10386.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9866.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",10386.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13502.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",10386.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,13502.13,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC",965,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8830.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",7064.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6792.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6452.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6792.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8830.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6792.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8830.35,
"HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC",969,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",49707.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",39766.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38236.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36324.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",38236.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",49707.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",38236.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,49707.72,
"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC",970,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22219.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17775.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",17091.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16237.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",17091.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22219.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",17091.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,22219.17,
"HIV WITH MAJOR RELATED CONDITION WITH MCC",974,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",24180.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",19344.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",18600.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17670.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",18600.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24180.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",18600.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,24180.68,
"HIV WITH MAJOR RELATED CONDITION WITH CC",975,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11627.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9301.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8944.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8496.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8944.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11627.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8944.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11627.42,
"HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC",976,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8532.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6825.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",6563.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6235,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",6563.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8532.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",6563.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,8532.11,
"HIV WITH OR WITHOUT OTHER RELATED CONDITION",977,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11648.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",9318.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8960.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8512.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8960.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11648.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8960.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,11648.73,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC",981,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",38428.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",30742.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",29560.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28082.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",29560.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38428.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",29560.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,38428.73,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC",982,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",20807.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16646.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",16005.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15205.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",16005.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20807.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",16005.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,20807.63,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC",983,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14933.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11946.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11487.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10912.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11487.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14933.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11487.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14933.4,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC",987,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",28460.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",22768.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",21892.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20797.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",21892.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28460.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",21892.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,28460.29,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC",988,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",14377.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11502.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",11059.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10506.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",11059.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14377.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",11059.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,14377.92,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC",989,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",10871.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8697.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",8362.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7944.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",8362.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10871.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",8362.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,10871.54,
"PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS",998,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",1409.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",1127.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",1084.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1030.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",1084.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1409.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",1084.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,1409.66,
UNGROUPABLE,999,MS-DRG,100,RC,,,INPATIENT,,,,,,950,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",1409.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",1127.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",,,,,,,0,"other ","not sperately reimbursable",1084.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1030.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1100,,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not sperately reimbursable",1084.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1409.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,"other ","not sperately reimbursable",1084.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",950,1409.66,